A challenging job for a CEO

Lizzette Yearwood, the longest serving chief executive officer of the Health Services Authority, took up the post in 2006 as the latest in a revolving door of changing senior management at the fledgling authority.

She stepped into an organisation that was trying to overcome financial and structural obstacles and into a job that many considered to be a thankless task and a professional quagmire.

Between 2002, when the Health Services Authority was established – after years of being a government department – and 2006, when Ms Yearwood was appointed, there had been five chief executive officers, five chief financial officers, three medical directors and four human resource directors in the authority.

“It seemed to be career death,” she admitted, recalling taking up the post at first. “But, to be quite honest, when I did take over, I found I had an incredible amount of support. I felt that the staff really wanted to change what had not 
been going right.

“I can truly say I was a little reluctant, I did wonder what support I would have from the ministry, the board and senior management,” she said. She found plenty, as it turns out, and in the early days of taking up the post, the team came up with a strategic plan of how to move the HSA along.

It took a few more years, but the Health Services Authority turned a financial corner in 2010, when it posted its first net profit of $6.2 million for the 2009/2010 financial year.

Much of the work involved in finally getting the authority into the black was done through streamlining processes, rather than across the board cost cutting, Ms Yearwood said, and she counts the financial turnaround as one of the major achievements of the HSA that she has seen since she became CEO.

Free health hurdle

One of the biggest challenges the authority has faced has been overcoming a culture of free medical care expectations, she said.

When the HSA was still the health department, Ms Yearwood said the law that made health insurance mandatory was not yet passed and many patients and even hospital staff thought medical care would be supplied without cost or that billing could be done long after a service was provided. As an authority, the HSA is supposed to generate revenue and that has forced staff and patients into a culture change, Ms Yearwood said.

“We’re still in the process of changing that culture,” she admitted. “The physicians have come on board and they’re doing a tremendous amount of work in that regard.”

“The staff understand now that we have to be self sufficient and that in order for me to pay their salaries at the end of the day, they are going to have to charge and collect our accruals on a daily basis,” she said.

Ms Yearwood has had a lifelong love of healthcare and wanted to be a nurse from an early age. She started her career in the healthcare service as a nursing aide in Faith Hospital in her hometown of Cayman Brac.

She completed her international baccalaureate between 1986 and 1988 at the United World College at St. Donat’s Castle, Llantwit Major, Vale of Glamorgan in Wales. After that, she went to the University of Miami where she completed a bachelor of science in nursing and qualified in 1992.

After university, she remained in Miami, working at the Children’s Hospital. “I developed a love for paediatrics,” she said.

She returned to Cayman in 1993 when her mother developed cancer. “I moved home to be with her.

That changed my whole life, I would probably still be in Miami were it not for her. In 1993, I came home and worked in the old paediatric ward and I worked as a senior staff 
nurse for seven years,” 
she said.

Intensive training

In 1998, she went to London to do paediatric intensive care training before returning to Cayman to work as a nurse until February 2000 when she moved into the field of quality assurance and risk management, in which she worked for three years.

She was then selected as a business manager for the surgical directorate at the hospital where she worked for a year, before being appointed deputy CEO in 2004. The following year, she became acting CEO and was confirmed as CEO in late 2006.

“People ask if I miss bedside nursing and the answer is definitely, yes. At the same time, especially in this role, I have the opportunity to, if not necessarily get hands on, I still get to the bedsides … I get to go to the wards and speak to the patients and the staff to get to understand what the issues are. The good thing is now I can make a change.

Before I was involved as risk manager but you had to put forward your proposals for policy change. Now I am actually in a position where I can change policies, with the approval of the board and can make a difference in the lives of patients,” she said.

Looking back at the last 10 years of the HSA being a government authority, she said: “It’s incredible what we have done and achieved.”

This year, the health authority will concentrate on quality, she said, and on “how to improve efficiency and productivity”. That is the focus of an upcoming national health conference which is hosted by the Ministry of Health and the HSA.

“That is the big thrust for us this year. We have a quality improvement team that is made up of and headed by physicians,” she said. This will help track productivity and outcomes and generate reports that will enable comparisons between departments.

Patient feedback

Another new initiative will be the introduction of in-depth patient feedback in which patients who have been seen by the HSA will be invited to give their impressions and comments online. “It’s important to look at feedback. We need to understand what we are doing well and if we are meeting the expectations of patients,” she said.

Married to Ian Yearwood, Ms Yearwood’s daughter Kelsey Dixon, 17, has followed her mother’s footsteps in doing her International Baccalaureate at a United World College in Costa Rica, but has no plans to enter medicine, as she is interested instead in computer science.

Ms Yearwood returns to the Brac regularly, mostly through her job as she visits Faith Hospital and also the clinic on Little Cayman, about four times a year and often stays for a weekend to visit with cousins and friends there on the Brac.

One person she felt she had to thank for the support she received when she took up the post of CEO was the late Pastor Al Ebanks, who was chairman of the board when she was appointed. “He promised he would be there as chairman to support me in my role and he truly was a man of his word.

Nobody knows the hours he spent in that chairman’s office, he really was an advocate for the patients and staff as chairman. I owe a 
lot to him,” said Ms Yearwood.