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Cover Story


Nancy Agee chats with Eva Smith in a patient care unit at Carilion Roanoke Memorial Hospital. Agee says that her experience as a nurse helps her make better decisions as an executive.


what it’s like to sit at the bedside of a patient. I can speak that language, and I do think that informs my decisions and it helps me be better at my job.” Agee learned early on that rules


can get in the way of patient care. She remembers a patient who hadn’t eaten all day and wanted something at 10 p.m. The kitchen was closed. There was no way to get food at the hospital, and Agee wasn’t allowed to leave the building. She left anyway, going to a grocery store to get the patient some pudding. Despite the fact she was helping a patient, Agee got a “dressing down” from her supervisor. “There were so many rules then,”


she says. “It was just this whole milieu of rules that didn’t make sense for the actual patient care. That was one of the things that affected me. How could I effect a change in that regard?” Agee remembers a cancer patient


fine, but I think incumbent on leaders is to look for the future … We’re here and we’re doing well, but what’s happening in the world and can we stay where we are? So, we began to explore options.” Those options ranged from changing


nothing at Carilion to transforming it into a for-profit corporation. The Caril- ion board decided it wanted to keep a lot of what the organization was at the time — a Roanoke-based nonprofit health system that was involved in medical education. The board members, however, also wanted change. They wanted to find a model that could carry Carilion into the future. “With that construct,” Agee says, “we began to look at what seems to be successful.” The board turned what U.S. News


& World Report called “a struggling clus- ter of traditional hospitals and clinics” into a physician-managed clinical model that puts doctors in charge. “They’re the ones that write the orders,” she says, “so they really needed to be much more integral into the delivery of care, to the decisions related to that. So physician leadership was very important.” Leading Carilion through the transi-


tion was Agee’s predecessor, Dr. Edward G. Murphy, who died in October at age 61. Murphy, who spent a decade as Caril-


22 DECEMBER 2017


ion’s leader, was instrumental, along with then-Virginia Tech President Charles Steger, in the creation of the Virginia Tech Carilion School of Medicine and Research Center beginning in 2007. While development of the medi-


cal school was universally praised, not everyone was on board with the clinic model at the beginning. Some physicians rebelled, refusing to work with Carilion under its new organization. Many of those dissenters have now changed their minds. Agee says the physicians’ support was greater than it seemed. “We had a lot of physician support,” she says. “So, even though there was this swelling concern, we actually had a lot of physician support for ‘Let’s do something different.’”


Patient care vs. rules Agee’s frontline experience likely


helped build that support. She’s sure it helps her management. Caring for patients, after all, is the principal reason for Carilion’s existence. “I think that, having come up from


the clinical side, I understand to some extent how hard it is to actually meet a patient’s needs, and so I do think that informs me,” she says. “I didn’t come up from the business side. I didn’t come up from the financial side. I actually know


who was in and out of the hospital so often he was a favorite with the staff. Agee came to work on a Christmas morning with presents and flowers for the patients her nursing team was serv- ing. She had yellow roses for everyone except that cancer patient. He was getting a red one. She was so excited to tell the other nurses about the gifts and her plans to slip them into rooms before patients woke up, she didn’t notice the empty room across the hall. The popular patient had died during the night. Agee says it was hard to lead her staff


when they were grieving. It was difficult “to accept their love and compassion and teamwork for me and to be the professional caring staff we needed to be on Christmas morning for the rest of our patients.” It was hard, but they did it. “It was


really teamwork at its best,” Agee says. “That’s something I always remember, too, how much stronger we are as a team, even in the hard times — maybe espe- cially in the hard times.”


Medical school, research institute Teamwork is at the center of the


medical school Carilion and Virginia Tech created with the help and support of local and state government. Aspiring doctors at Virginia Tech Carilion School of Medicine train with students from Carilion’s Jefferson College of Health


Photo courtesy Carilion Clinic


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