Two things are apparent from the start of the day at United Regional Health Care in Wichita Falls with Phyllis Cowling, CEO. The first is that she, without question, loves her job and all the people who are a part of it.
The second is that while she certainly does not take herself too seriously, she has a depth of experience and insight that come from years of pushing herself and her organizations toward the highest level of excellence.
“One of the things I’m very fond of saying is that my job is to keep us just a little uncomfortable – because change doesn’t occur when you’re comfortable,” said Cowling . “So my job is to keep my team just a little beyond our comfort zone.”
Laughing, she said, “And they usually respond – ‘And a fine job you’re doing, Phyllis! You’re doing a great job keeping us uncomfortable.’”
Over the 30 years Cowling has spent leading health care organizations, her drive to create a little bit of discomfort is not just an expectation she has held for her teams. It's also a standard she has held for herself, both personally and professionally.
As Cowling prepares to take over as chair of the Texas Hospital Association board of trustees in January 2018, that standard translates into her goals for the association. The way she sees it, the need to evolve and grow and not be complacent is essential for not just her own hospital but for the entire Texas hospital industry.
Beyond the Numbers
“When I was growing up, I didn’t have aspirations to be in health care,” said Cowling. In her early years growing up in the small Texas town of Bridgeport as the youngest of four children, Cowling considered a lot of different career paths for herself.
It wasn’t until her first years at then East Texas State University (now Texas A&M University-Commerce) that a suggestion from her father put her on a path that would – eventually – lead her to health care. “My father actually suggested that I take some accounting classes, maybe an economics class. He said, regardless of what you do, those skills will help you.”
She discovered she enjoyed the work and asked to be assigned to additional health care projects. “I figured out that, yes, I do like health care accounting, but I also realized that I didn’t want to be an auditor all my life.”
Her desire to stretch her skills beyond the role of auditor sent her to Austin to pursue an MBA from The University of Texas. After graduating, a suggestion – and as it happened, a strong recommendation – from Roger Picket, then managing partner of Arthur Andersen, took Cowling to her first position at a hospital. In 1987, she became internal auditor for then Garland Memorial Hospital, led at the time by Gary Brock as CEO. Brock, now executive vice president, chief integrated delivery network officer at Baylor Scott & White Health, became a key influential figure in her career.
Gary Brock recalled his first meeting with a young Cowling. “I was impressed with her and because of a strong recommendation from Roger, hired her as my internal auditor,” remembered Gary Brock, also former chair of THA.
“Five months go by, I ended up changing my chief financial officer, so Phyllis moved from my internal auditor to my CFO. She was 25 years old at the time – so she had big shoes to fill quick. She obviously did a yeoman’s job.”
Early on in her career in health care, Cowling found a mentor in Brock, who not only pushed her to test her skills not just as a young CFO, but also exposed her to experiences that were broader than a CFO’s typical role.
Gary recalled, “I think we both learned from each other. She was very interested in many things so I would give her opportunities to work in other areas of the hospital that back then, a CFO wouldn’t have been involved with– she got involved in quality; she got involved in marketing; she helped me set up an inpatient rehabilitation unit.”
“So we stretched her from just being a CFO to being a health care executive,” said Brock.
Cowling said of those years at Memorial Hospital in Garland, “It was a small team. Gary was so generous in letting me be more than a CFO...I think what I take away from those early years is a gratitude, quite frankly, to Gary and others who gave me that opportunity to go beyond finance.
“I love finance but it served me well to see beyond those numbers. I always say it’s knowing what’s behind the numbers that’s important and I got that opportunity to see that,” said Cowling.
Gaining Perspective Far from Home
Ted Shaw, current THA president/CEO, was Cowling’s first external auditor during his time at Ernst & (then) Whinney, more than two decades ago while she was CFO at Garland Memorial. At his suggestion, Cowling joined the Healthcare Financial Management Association in 1987. The organization gave her a chance to gain valuable insight with other leaders in hospital finance from across the United States.
“Selfishly,” Shaw said, “I wanted her help with the Lonestar chapter of HFMA but I also felt that HFMA would give her a great perspective and network of peers, leaders in health care finance from around the country.”
In 2002, she was named board chair for the national chapter of HFMA. At the time, she served as CFO for Baptist St. Anthony's Health System in Amarillo.
Her leadership roles at HFMA gave her the opportunity to represent the organization abroad and meet with health care leaders around the world to compare other health care systems. She described her first trip to Moscow, “I admit I wasn’t always a very avid – especially international –traveler.
"When I got on that plane in Chicago, by myself of course, knowing that I was going to touch down in Moscow – I admit I was a little out of my comfort zone. But by the end of that trip, 10 days I believe, I was already asking, ‘Where do we go next?’”
Those first trips with HFMA took her to Russia, South Africa and Brazil, sparking a lifelong love for international travel. When asked what she brings back to her current role from her travels, she said, laughing, “Well, first of all, I bring back all the art work that’s in my office.”
But, she said on a more serious note, “One thing is that anytime you can expose yourself to something out of your comfort area, it’s a positive. So (travel) is about stretching those boundaries.”
She said her travels, especially those meeting with other hospital leaders, afforded her a key lesson that is at the root of her mission today. “There’s no such thing as a perfect health care system – particularly finance system. But we’re all trying to do the most good for the broadest number of people.
“The thing that always comes back to me as I go to different places, across continents – we are much more alike than we are different,” she explained.
Today, Phyllis Cowling leads United Regional Hospital in Wichita Falls. The 325-bed nonprofit hospital serves as the only comparably capable hospital for 200 miles west of the city and is the only Level II Trauma Center and Primary Stroke Center in the region.
During her time as CEO, Cowling oversaw a large expansion of the hospital’s campus and capabilities, as well as earning national recognition for excellence in patient care. In 2013 and 2014, United Regional was named one of the Top 100 Hospitals in the nation by Truven Health Analytics. In addition, it was named an Everest Award winner in 2014, one of only 14 hospitals in the nation awarded the designation, which measures long-term improvement of a hospital.
A key part of her focus for the hospital stems from United Regional’s role as the main provider of care for such a large area. “I have a strong passion for what we do here and that is in part because we’re it in our community. We have an 82 percent market share in our primary service area. People rely on us,” said Cowling. “If we’re not here or we’re not providing excellence, it isn’t as if our community can go ‘ok, I’m going over to XYZ hospital.”
Again, for Cowling it comes back to providing excellent patient care. She said, “I acknowledge we can’t deliver the same scope or breadth of services offered at say a quaternary care hospital in Dallas. But what we can do, we will do very, very well. Because I don’t believe you should have to live in a large metropolitan area to get great health care.”
Her Vision for THA
As Cowling prepares to take over as THA board chair in 2018, she is frank about some of the challenges facing hospitals in Texas. The biggest of those challenges, she said, is uncertainty of government funding for health care.
“It’s the question of what’s going to happen at the federal and, ultimately, state level. There’s no question that all of us – regardless of whether we are big or small, rural or urban, for profit, not for profit – we all depend very heavily on governmental funding.”
She hopes to see the Medicaid 1115 Transformation Waiver extended, but her concern is broader, looking to the work to be done around the funding mechanisms of health care going forward. She explained, “There’s limited dollars, and I can guarantee we’ll all be tugging – we’re all going to want some part of the pie. I believe that’s going to challenge our ability to come together – it always has in the past and I suspect it will in the future.”
Her primary goal, she explained, is to help find common ground across the membership. “I want to continue to strengthen that commonality of voice for THA.”
Gary Brock, for one, is optimistic that she will be able to meet that challenge.
“I think the work that she has done over the years has really prepared her well to deal with the diversity of issues that the various constituencies at THA have,” said Brock. “I think she’s going to do a phenomenal job of being able to listen, process the information and come up with ways in which we can move forward as an association, with hopefully more of one voice than maybe we have had in the past.”
She is pragmatic while still optimistic. “We recognize that sure, there are always nuances and differences between organizations but let’s capitalize on what we each bring to the table and then make the whole greater than the sum of the parts.”
No one, certainly, should be surprised that Cowling is again willing to step up to push herself and an organization beyond what’s always been done in order to grow, evolve and become stronger.
“She’s a remarkable lady,” said Brock. “I think she’s going to be a community builder and a strong advocate for the association.”