University of Washington School of Public Health
Close Up August 2015: Dennis Stillman
What impact is the Affordable Care Act having on the way you prepare MHA students as future health care leaders?
The fun thing right now, I think, about the whole Obama-care idea is that it’s forcing the system to think about health care differently. We’ve been paid for years to do things, to treat things – and we’ve gotten really good at that.
The Affordable Care Act says let’s get away from paying for individual treatment, look at the population, and pay providers to keep people healthier. It’s more of a public health focus.
We have to get the students ready for a change. Nobody knows what’s going to happen in five or 10 years. What’s the direction? How do you look at populations versus individuals? A big part of the health administration role is how to make the most effective use of resources, how to make your systems work well, how to decide which is the best intervention to take.
Are there any parallels in your experience?
In 1984-85, hospitals switched to paying in DRGs, or Diagnostic-Related Group (a system of classifying patients, based on diagnoses, for Medicare reimbursement). You admit the patient, you know how much you’re going to get paid. It was a fundamental shift in how you had to think about taking care of patients.
Just as with the Affordable Care Act, people said, “Health care’s going to go down the tubes. Quality’s going to disappear. It’s just terrible.” Well, length of stay dropped almost overnight by two or three days. Health care outcomes went up. There’s fear about radical change, but it forces you to change the way you do things.
What’s new in the MHA program?
We’ve just hired three new senior lecturers. It’s a real practitioner-focused faculty. We’re training people go out and do things. But we’re also trying to supplement that with a research focus. We’ve hired an associate and an assistant professor with specialties in information and organizational design.
We’re also going to integrate ethics, information and IT, and management and leadership into every course. Resource allocation is an ethical decision. It’s also a leadership decision – how do you tell someone they don’t get the resources they believe they need to take care of their patients? And how do you get good information? It’s not just the one competency.
What drew you to the health-care management field?
I got into health care because of the Peace Corps. They sent me to work as an accountant with a government-run group of 13 hospitals in Brazil in the early 1970s. I worked in Paraná, which was coffee and timber country. We cooked on wood-burning stoves and sorted laundry on the cobblestones.
- Senior Lecturer, Health Services
- Interim CFO, various, 2006-present
- CFO, UW Medical Center, 1987-99
- MHA, UW, 1979
- BA, Business Admin, University of Puget Sound, 1971
When I came back, I worked for four years as a hospital accountant, then got into the MHA program at the UW in 1977. Bill Dowling, who was instrumental in creating the program in the early ‘70s, had me teach an accounting class to my fellow students.
What did you get out of the MHA program?
I learned how to write. Other people learned how to do math. We also learned to work in teams. It exposed me to health care from the clinical side, which I hadn’t seen working as an accountant. It softened my accounting skills.
You went on to become chief financial officer for UW Medicine. What brought you back to the MHA program?
I started teaching in about 1998 when we started a program for mid-career physicians and nurses. The aim was to educate them, especially in management and leadership. They needed somebody to teach accounting and finance. At that time I decided to spend the next 20 years of my career teaching and influencing health care through students, versus running an organization.
How many students have earned an MHA here?
About 1,300 since 1972. Each year we aim for about 30 executive (or mid-career) students and about 30 MHA day students (new graduates or those with four to five years of experience). They are two very different populations. Day students need the context of the health care system. Mid-career ones already know all that, but they don’t know the business side.
In some ways, business is almost a nasty word. You know, “Don’t talk about money. That shouldn’t interfere with our decisions.” So how do you get them comfortable talking about the business issues of running very complicated organizations that have huge resources?
What are you most proud of?
I worked for PacMed (Pacific Medical Center, in the Art Deco building on Beacon Hill that was formerly leased by Amazon) for about two years as CFO. I was really the one responsible for getting it out of the inpatient business. It was a full blown hospital. I was there for about two weeks and said, “We can’t afford to do all this stuff.” Other hospitals picked up our employees so no one would lose their job. It was the right thing to do, but it wasn’t popular. Thirty years later, PacMed is still around (in the form of nine clinics), taking care of indigent patients.
What was the most difficult thing you’ve ever done?
The most challenging thing was being a subpoenaed witness at a Senate hearing in Washington D.C. It was about a compliance and billing issue over using state money to subsidize liver transplants. There was a hooded witness in the room (a whistleblower). The only other time they’ve had a hooded witness was when Bobby Kennedy was prosecuting the mob.
What do you do when you’re not working?
I love to ride bicycles. I rode across the country in 2010. My partner, Tricia, is a bicyclist. I still play basketball at the UW. That’s the hardest thing I’ll ever have to give up. It’s the closest thing to meditation. I don’t think when I’m playing basketball.
I like live music, and played tuba in college. Music showed me the value of teamwork. That’s what management is about. And that’s what sports are about. How do you work together to get something done? If it works right, you’re going to be better together than the individual parts.