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Case Study 5 Ellen Zane—Leading Change at Tufts/NEMC Cynthia Ingols Lisa Brem
Simmons College School of Management Boston It was a difficult decision to take this job.
But there was something about the history of Tufts -NEMC and its importance to so many
stakeholders that really grabbed me as the epitome of what one could do in one’s career. I’d
also learned not to be adverse to risks. You have to take risks, not stupid risks, but you have
to take risks. — Ellen Zane, CEO, Tufts-NEMC Source: From Linda E. Swayne, W. Jack Duncan
& Peter M. Ginter. Strategic Management of Health Care Organizations. Jossey-Bass. 2008.
Ellen Zane brought a cup of coffee into her home office. It was 4:30 a.m. and she was, as
usual, starting the day early. She fired off a few e-mails to her senior staff and looked over
the Women’s Business magazine on her desk. Her photograph was on the cover,
highlighting the article on the turnaround she was attempting to execute at Tufts New
England Medical Center (Tufts-NEMC). It was the summer of 2006 and it had been an
incredibly rough two and-a-half years since she accepted the CEO position at the ailing
Boston hospital. Since then the hospital had survived the worst of its financial troubles—
they were meeting efficiency goals and for the first time in years, more doctors joined the
hospital than left it. Tufts-NEMC posted an $18 million gain in 2005, after losing nearly $60
million since 2001 (see Exhibit 1 for financial statements). People were smiling and
thanking Zane in the corridors. But that was a piece of the problem. This was the tricky part,
she thought, in one of her rare moments of quiet as the predawn light slowly infused the
room. Zane realized that she was still deeply worried about the future: This place was just
so fragile and I still consider it fragile. It’s one month forward and one month back. This
market is unforgiving and tough—I swim with the sharks and nobody glad-hands us. I tell
the staff all the time—not a minute do we take our foot off the gas. Zane struggled with how
to maintain the solidarity that the financial crisis had created among Tufts -NEMC’s 5,000
employees.1 She knew from her 30 years of experience in hospital management that
sustaining change in Boston’s cutthroat medical industry was the hardest part of any
turnaround. She had been successful before with Quincy Hospital, but Quincy had been a
much smaller player. Tufts-NEMC was a 450-bed Academic Medical Center (AMC) that was
the primary teaching site for Tufts University School of Medicine, and conducted over $50
million in research each year. It had 17,000 admissions in 2005 and generated $600 million
in revenue. Unfortunately, while Boston’s other AMCs merged, built networks, and grew
stronger, Tufts-NEMC had for years floundered directionless in Boston’s rough seas. As Zane
headed to her office overlooking Boston’s Chinatown she wondered: How could she create

and sustain true and lasting change for Tufts-NEMC? The Health Care Industry in Boston
“Health care, together with education and computer technology, is what Massachusetts is
known for throughout the world.”2 Home to several high-profile Academic Medical Centers,
the Boston area was a world -renowned destination for health care services. Massachusetts
General Hospital (MGH), Brigham and Women’s Hospital (BWH), and Beth Israel/Deaconess
Medical Center were affiliated with Harvard Medical School, Boston University Medical
Center with Boston University, and Tufts-New England Medical Center with Tufts. These
large AMCs led the way in capturing $2.3 billion in National Institutes of Health (NIH)
research grant money, second only to Ca lifornia. Massachusetts hospitals employed 12.2%
of the total labor pool, and accounted for a whopping 11.7% of the gross state product.
Health care expenditures per capita were between 27% and 29% higher than the national
average from 1990 to 2000 (see Exhibits 2–9 for Massachusetts health care statistics).
Consumers, health plans, and governing bodies tended to accept that heath care in Boston
costs more in accordance with the high quality and cutting-edge services the region
provided. Nationally, however, years of underfunding by federal and state governments and
rising enrollment left Medicare and Medicaid payments lagging behind surging medical
costs. Hospitals in Massachusetts and the rest of the nation amassed significant debt in the
1970s and 1980s as they refurbished older facilities, expanded services, and purchased
expensive new technologies. While reimbursements fell behind rising costs, hospital
discharges declined sharply in the 1980s, as did the average length of stay. In
Massachusetts, a decrease in hospital births and nonresident discharges3 led to an overall
decline of 24% in total hospital disch arges from 1991 to 1996. The increase in outpatient
surgeries also affected hospitalizations. 4 Throughout the 1990s, Massachusetts health care
insurance plans followed nationwide trends when they merged into three large
competitors: Harvard Pilgrim Health Care, Blue Cross/Blue Shield of Massachusetts, and
Tufts Health Plan. These “big three” plans wielded increasing power in the marketplace, and
their movement to managed health (HMO) plans resulted in lower payments to providers 5
and more oversight on costs and medical services. All three expanded regionally, to entice
large regional and national companies to offer their plans to employees. HMOs used
capitated payments, meaning they reimbursed providers based on the number of “covered
lives” in the provider system. Thus, providers of health care services such as hospitals and
doctors believed volume and efficiency of services to be the most important factors in
future financial success. In 1991 Massachusetts deregulated hospita ls for the first time in
ten years. These conditions succeeded in making an impact—threatening the financial
viability of hospitals and moving them toward more efficient and cost effective management
practices. Boston’s health care leaders struggled for a strategy to survive in the new
environment. Mergers, closures, and conversions loomed. The leaders of MGH and BWH
made the first decisive move. Managers at both hospitals believed they needed additional
leverage to hold their own in negotiations with the ever more powerful health insurance
plans. They also envisioned building a network of community primary care and specialist
providers who would refer tertiary 6 patients to the member hospitals, thus bolstering
volume. In 1994, when the news of the merger of these two behemoths — forming Partner’s
Healthcare System, Inc. (Partner’s)—became public, it was a seismic change in the

landscape of the New England medical industry. Others quickly followed suit. From 1990 to
2000, there were 47 acquisitions and mergers and 19 acute care hospital closures, not
including the formation of 10 major hospital systems in Massachusetts.7 Following the
market consolidations in the 1990s, the turn of the twenty -first century years were difficult
ones for Boston’s hospitals and insurers. Both Harvard Pilgrim and Tufts Health Plans were
hindered by regional overexpansion. In 1999, Harvard Pilgrim went into receivership after
posting a $226 million loss, while Tufts Health Plan lost $42 million. Community hospitals
also continued to struggle from high debt, inadequate reimbursements, high labor and
pharmaceutical costs, and failed merger or network integration attempts. In Massachusetts
particularly, consumers began to migrate to the more expensive AMCs f rom the smaller
regional or community hospitals, seeking what they perceived to be higher quality of care.
Cuts in payments from Medicaid, Medicare, and private insurance plans continued to plague
many providers. To encourage more efficient management and cost containment practices
among its providers, HMOs started to move away from capitated care and toward pay -
forperformance plans. Even some AMCs felt the pressure on their organizations. CareGroup
— another Massachusetts-based hospital umbrella organization—posted a loss of $215
million over 1999 and 2000 and lost market share and network physicians. Partners,
however, grew and remained strong, reaching 5,600 doctors in its Partner’s Healthcare
System, Inc. (PCHI) network. In a seminal flexing of its market strength, Partner’s negotiated
up to 30% increases from all three major health plans, at one point refusing to continue a
contract with Tufts Health Plan until it agreed to higher payments.8 By 2005, the provider
market was dominated by four major hospital systems: Partners, reporting a surplus of $30
million; Caritas Christi; CareGroup (which had decentralized most of its operations back to
its member hospitals); and Boston Medical Center. See Exhibit 10 for provider descriptions.
When the dust settled on the consolidation activity, there were approximately 25 acute
care, five psychiatric, and five rehabilitation hospitals in the metropolitan Boston area, with
Partners leading in market share. 9 On the insurer’s side, the major health plans recovered,
with Blue Cross/Blue Shield of Massachusetts coming out on top, Harvard Pilgrim regaining
strength, and Tufts maintaining a third position. According to one survey of the Boston
health care industry, trends through 2005 were: • • • • AMCs faced lack of capacity from
years of merging and downsizing, while admissions moved to AMCs from community
hospitals; pay-for-performance (quality incentive) programs were gaining in popularity,
using measures such as cost, efficiency, IT capacity, admission rates, and patient satisfaction
to bolster reimbursements; hospitals struggled to recruit new doctors and nurses, with
AMCs poaching from each other; nationally, the growing number of uninsured and
underinsured people increased the amount of bad debt hospitals carried. Although
mitigated in Massachusetts by strong safety net programs, collections were still a rising
concern.10 History of Tufts-NEMC11 New England Medical Center, originally the Boston
Dispensary, was one of the oldest hospitals in the United Stat es. Started in 1796 by the
philanthropic activities of historical Boston figures Samuel Adams and Paul Revere, the
Boston Dispensary was the first permanent medical facility in New England. First
envisioned as a community medical service for the poor, the hospital quickly gained a
reputation for innovation. It was the first U.S. hospital to assign nurses to patients, to form a

visiting nurse association, and establish dental, rehabilitation, venereal disease, lung, food
and nutrition, and evening pay clinics. It pioneered employer-paid clinic treatment, well-
child services, and moving x-rays. The first modern test for syphilis, the first group
psychotherapy experiment, the first human growth hormone, and immuno-suppression
therapies were developed at the Boston Dispensary. In 1929 New England Medical Center
was formed by the merger of the Dispensary and Tufts College Medical and Dental Schools.
By 1965, it added the Floating Hospital and the Pratt Diagnostic Clinic –New England Center
Hospital.12 In recent years, the tradition of innovation continued, with strong programs in
cancer treatment, transplants, and neurosurgery. In 1992, with the addition of a maternity
service, Tufts-NEMC became the first full-service, private teaching hospital in Boston. The
Neely House, opened in 1997, was a unique bed and breakfast style home located within the
hospital for cancer patients and their families. And in 2001, Tufts-NEMC opened a
transplant exchange program, the first of its kind in the U.S. which allowed family members
of transplant patients to donate kidneys to patients on the global waiting list, thus
increasing the number of organs available for transplant. Financially, however, Tufts-NEMC
was struggling. Although in the 1990s the hospital had posted gains, it was largely due to a
write-down in assets, and not improved efficiency or an enhanced revenue cycle. The
hospital had fallen prey to the same negative market forces that had taken their toll on
other non -affiliated hospitals in the 1990s. By 1996, it was $240 million in debt (up from
$130 million in 1990) and was losing physicians, market share, and hospital acquisitions to
Partners and CareGroup. Like many AMCs, Tufts-NEMC was slow to react to market
pressures, and ineffective in improving processes and cash flow. In a particularly
devastating blow to the hospital, Harvard Pilgrim Health Care discontinued coverage to
Tufts-NEMC in 1995, citing high costs. As Zane explained: Harvard Pilgrim HC had taken
Tufts-NEMC out of their network and it had almost killed the place. A doctor in Hyannis
wants to send a patient to Boston. He or she has to ask “does this patient have Harva rd
Pilgrim?” The situation caused doctors to have to think too much about insurance. It was
just easier to send everybody to the Brigham. So, for Tufts-NEMC, not being in that contract
was incredibly hurtful. The Lifespan Merger In the mid-1990s, Tufts-NEMC began to
actively look for a partner to remedy its fiscal dilemmas. It needed more clout against the
health plans, more referrals from community hospitals, and a partner with deep enough
pockets to help pay for growth to compete with Partners, CareGroup, and the other Boston
systems. It was in talks with Columbia/HCA, a for-profit hospital chain from Tennessee that
wanted to expand its presence in New England. If the merger went through, it would be the
first AMC owned by a for-profit company in New Engla nd. This did not sit well with some of
the board members, faculty, and community, who strongly wanted to preserve Tufts -
NEMC’s non-profit nature. In late 1996, the hospital was treating a high-ranking official
from the Lifespan Corporation, a regional non -profit hospital system formed in 1994 with a
merger of the Miriam and Rhode Island hospitals. 13 One of Tufts-NEMC’s physicians
explained the hospital’s dilemma and talks began between Lifespan and Tufts-NEMC to
merge. TuftsNEMC leadership saw benefits to joining with Lifespan, such as needed capital,
a chance to gain back the Harvard Pilgrim Health Care contract, and the potential referrals
from the Rhode Island system. On Lifespan’s side, TuftsNEMC was enticing for its status as

an AMC, its base in Boston, and its expertise in high -level care. The merger would create, as
one journal wrote, “a $1.5 billion, 14,500 -employee health care giant with the ability to
serve 70 percent of the entire New England market” and would rival the $1.8 billion
Partners system and $1.1 billion CareGroup.14 In January 1997, Tufts-NEMC and Lifespan
officially announced the merger, which became effective in November of that year. Ed
Schottland, Senior Vice President–System Integration at Lifespan and appointed COO at
Tufts-NEMC at the time of the merger, explained: Lifespan was interested in Tufts-NEMC
because it gave them instant access into Boston and made them the regional system they
wanted to be. The plan was to create Lifespan of Rhode Island a nd Lifespan of
Massachusetts—of which Tufts-NEMC would be the hub—both overseen by an overarching
corporation. Tufts-NEMC is a tertiary and quaternary 15 medical center, we do bone
marrow, solid organ transplants, and we have a neonatal intensive care unit. They didn’t do
any of those things in Rhode Island. The only BMT 16 program allowed in Rhode Island was
at Roger Williams Hospital. So Lifespan got instant access to highest levels of care. The
merger filled out the service complement with a high class, well respected organization with
great outcomes and great medical care. Everyone assumed that we would be able to direct
our patients here from Rhode Island. We would have a system of care, just as Partners was
trying to do with their North Shore hospitals. The marriage was not a happy one however—
the hoped-for synergies never materialized. Rhode Island regulators objected to large
amounts of capital migrating to Boston and required Lifespan to reduce the amount Tufts -
NEMC was to receive to $8.7 million a year for 10 years, down from 30 years as originally
planned. Although Harvard Pilgrim did eventually re-contract with Tufts-NEMC, some in the
industry believed that legislation or litigation would have forced that outcome regardless.
The referrals also did not pan out. As Schottland explained: Physicians make their own
decisions about where they refer. Physicians like to refer primarily based on personal and
professional relationships. A secondary reason they didn’t refer to Tufts-NEMC was they felt
that if they started to support a program here they might never get approval within the
Lifespan system to get that program down in Rhode Island. This was a unique system since
there were two medical schools—Brown and Tufts. The Brown faculty wanted to have the
programs, like bone marrow transplants, in Rhode Island. So there was a certain reluctance
to cooperate at times. Another problem with the merger was the “brain drain”. Lifespan
took many of the administrative and support functions out of Tufts-NEMC and centralized
them in Rhode Island. Tufts-NEMC lost their human resource, finance, purchasing/supply
chain, and IT, an area where Tufts-NEMC had been groundbreaking in the past. The
anticipated growth in acquisitions also failed to ta ke place. Hospitals that had previously
affiliated with TuftsNEMC, such as Faulkner, another Tufts Medical School teaching site,
joined Partners instead, while Tufts -NEMC was busy finalizing its merger with Lifespan. In
2000, Lifespan/Tufts-NEMC also lost Hallmark Health System in Malden. As one industry
journal wrote: Every time a decision had to be made, Tufts-NEMC President and Chief
Executive Officer Tom O’Donnell, M.D., traveled 55 miles across the state line to Providence,
R.I. There he conferred wit h the 21-member board of his parent system, Lifespan Corp. He
would return to meet with his own 21 -member board, then respond to Hallmark. […] The
extra corporate layer proved to be too much. Hallmark, at the time a four-hospital system,

walked away from the deal.17 Adding insult to injury, Quincy (Mass.) Medical Center and
MetroWest Medical Center spurned Tufts -NEMC, citing that the “local hospitals did not
think of Tufts-NEMC as a Massachusetts hospital.” 18 But perhaps the worst thing about the
merger was that insurance contracting was done in Rhode Island. Lifespan did not
understand the cost of doing business in the Boston market and therefore settled for
reimbursement rates far below the average for an AMC in Boston. Lifespan, struggling to
keep control of five acute-care hospitals, suffered an operational loss of $34.1 million on
total revenue of $1.3 billion ending fiscal year 2001. Zane explained her take on the Lifespan
merger: When Partners came together it freaked out the whole market and everybody was
looking for a partner. Long story short, Tufts-NEMC hooked up with the Lifespan system in
Rhode Island. I could not understand why they did it. It was an ill fated, ill conceived, ill
constructed, and ill-implemented merger and it had no meat on the bone. The health care
market in Rhode Island might as well have been Siberia it was so different from eastern
Mass. In the summer of 2002, five years after they merged, both Lifespan and Tufts-NEMC
agreed to separate at a cost of $30 million to Tufts-NEMC. Financial results for Tufts-NEMC
for fiscal year 2002 were dismal—a loss of $12.3 million on revenue of $476 million; and
2003 was looking worse—a loss of $38.5 million on revenue of $582 million. The
Massachusetts Attorney General’s office stepped in to ensure that the hospital would meet
bond covenants. O’Donnell and the chairman of Tufts-NEMC’s board called Ed Schottland
and enticed him to come back as COO. Schottland took the job and set about recreating the
adm inistrative departments lost in the merger. He also started initiatives to stem the
millions of dollars that Tufts-NEMC was losing monthly. Schottland targeted improvements
of $30 million in cost savings in the supply chain and human resources. He began a year of
initiatives designed to improve the bottom line. In the first nine months of 2003, Tufts-
NEMC reduced staffing levels by 200 FTEs through attrition and consolidation and made
improvements in supplier contracts. The hospital also began to look at selling some of its
1.5 million square feet of prime real estate to gain needed capital. The Board, meanwhile,
set about looking for a leader who could take Tufts-NEMC out of the shadow of Lifespan and
orchestrate a true turnaround. Ellen Zane Ellen Zane was educated at Waltham Public
Schools, and later graduated from George Washington University and Catholic University in
Washington, DC with masters in both audiology and speech language pathology. She spent
her entire career in health care, starting in 1975 as a speech language pathologist at
Lawrence (Massachusetts) General Hospital. In 1979 she took a job as director of speech
and language pathology and audiology at Morton Hospital in Taunton. Under the
mentorship of the COO of Morton, Zane worked her way u p to vice president of
professional services until taking the COO job at Quincy (Mass.) Hospital in 1987. When
Quincy’s CEO left in 1990, both Quincy’s board and the city’s mayor convinced Zane to take
on the task of turning around the hospital, which was on the brink of closure. Like many
community hospitals, Quincy had taken out bonds to renovate its ailing facilities. When the
Medicaid/Medicare and HMO reimbursement rates lowered drastically, Quincy found it
almost impossible to meet payroll and other expenses. Hampered by years of nepotistic and
political hiring practices and high competition in the surrounding area, the hospital was in
danger of defaulting on its bonds. Zane recalled her decision to take the job at Quincy as the

most difficult in her ca reer: It was the hardest decision I ever had to make, since I really felt
that failure was not an option. Closing a hospital as the result of my first CEO job would have
been awful. However, at the same time, women weren’t getting CEO jobs. I needed an
underdog job to try to prove myself, since it wasn’t likely that a woman was going to get a
job at what I called a “Bloomingdale hospital”—Mt. Auburn, Newton, Wellesley, Beverly, or
South Shore. Those weren’t coming to women in those days. But the main reason I took the
job was that I could see the steps it would take to fix it. When I had a very quiet, private
conversation with myself, I knew that if I could figure out the road map of what to do, then I
would just need the grit to do it. And I could see the way. So I jumped off a cliff and took the
job. It was the best decision I ever made. From a grass roots point of view the opportunity I
got at Quincy was the bedrock foundation to my management prowess. And it was really
hard. It taught me not only the value of risk, but it taught me that if you took a job that no
one else wanted to do because it was too hard, then all the benefits accrue back to you. If
you are successful at it, you are only better because it was harder. All these good old boys
with th e cushy jobs around me at richer hospitals, I believe, aren’t as good at managing
simply because they didn’t have to be. Quincy was unique in that it was managed by HCA, a
for-profit hospital management chain that owned and managed hospitals across the U.S. In
addition, Quincy had a strong union and civil service workforce. Working for HCA honed her
business acumen and decision-making abilities. Working with unions helped Zane
understand the need for clear, open, and honest communication and financial transparency.
As Zane recalled: I sat down with stewards of all the unions and showed them the financial
statements and highlighted all the things I wanted them to learn, like days cash on hand and
cash reserves. I taught them the meanings of those things and explained that we had no
money and that I was worried about meeting payroll. One of the biggest joys of my career
came when I left Quincy hospital and met with the stewards for the last time and one union
steward said to me: “How many days cash on hand do we have?” The fact that they had
learned that and appreciated it taught me the value of transparency, the value of admitting
that I needed help and I couldn’t do it alone. She also learned the importance of reaching out
to the community. As Zane explained: I got in my car and drove out to community doctors
who weren’t referring many patients to us. I asked them: “What would it take for you to use
Quincy Hospital?” They said simple things like parking. All the construction had closed the
parking lots. It was not that intellectually complex. The doctors also complained that
employee work ethic was dismal. The employees didn’t smile or pick up a candy wrapper
off the floor. They treated the hospital as though it existed solely for them and their
paychecks. They didn’t believe the day of reckoning was coming. Hearing that from the
community doctors was incredibly valuable for me. After a successful run at Quincy, she
was tapped in late 1993 for a groundbreaking job with the nascent Partners organization.
As Zane recalled: I got a call from Dr. H. Richard Nessen. He was the CEO of the Brigham and
Women’s Hospital. He told me they had just gotten permission from the Attorney General to
merge the General [MGH] and the Brigham [BWH]. This was huge, giant, gargantuan news.
He told me they wanted to build a vast network of physicians throughout eastern
Massachusetts and that he wanted me to come run it. I told him I had no idea how to do that
job, but he said that no one did, it was completely new. He said he needed a leader. He told

me that he had academic physicians who were lining up at his door to do this job, but that
he didn’t want to give it to any of them. He felt that academics wouldn’t understand
community doctors or community hospitals, and would turn them off. He was right about
that. Zane was successful at building what came to be called PCHI, 19 Partners Community
Heathcare, Inc. At Partners, she gained expertise at negotiating affiliation agreements with
physicians and contracts with health plans, and with building consensus with disparate
groups. Zane recalled her time at PCHI: I went from this incredibly resource poor
environment at Quincy, where I was plugging holes and trying to meet payroll, to this
environment that was so resource rich. There were so many smart people around, but there
was no trust between the Brigham [BWH] and the General [MGH] people, they were fierce
competitors for years. So each committee had to have counterparts from each organization.
Trying to develop a strategy in that environment was a challenge. The committees were
made up of type A personalities who wanted me to build a network overnight. I felt this
intense need to get the strategy going very, very quickly. So we spent the summer of 1994
building the strategy. The most incredible thing for me is, when I go and talk to investment
bankers or health plans now, PCHI is all they talk about. PCHI was the most formidable
market transforming activity other than the [MGH/BWH] merger itself. PCHI is the 800-
pound gorilla in this market. And I knew it and started it before it even had a name. It was
very rewarding, and very hard. As Partners grew, so did their clout in the marketplace. Zane
was the lead negotiator in the famous clash between Partners and Tufts Health Plan, which
culminated when Partners decided to no longer accept Tufts subscribers due to the plan’s
low reimbursement rates. Her bargaining skills and strategic planning won the day for
Partners. In the end Tufts agreed to substantial rate increases. After that encounter, Zane’s
reputation as a tough and savvy negotiator became legendary. Zane Moves to Tufts-NEMC
In late 2003, after 10 years with Partners, Zane was thinking of slowing down. Her husband
had sold his successful business and had retired and Zane was hoping to do the same. She
was getting ready to give her notice at Partners when she received a call from Lawrence
Bacow, the President of Tufts University. Bacow was on the board of Tufts-NEMC, which had
recently decided to dissolve the merger with Lifespan. He was looking for a new leader for
Tufts-NEMC, and felt that Zane had the right mix of skills to build and implement a succ
essful strategy for the hospital. Met by her initial reluctance, Bacow reminded Zane of the
hospital’s historical significance, its importance for its 5,000 employees, Tufts University,
and Chinatown’s economy. Zane recalled her reaction after the meeting with Bacow: There
were two enormous feelings that came over me. One was on the positive side: wow this
could really be important. To help this ailing organization means to really help a lot of
people in their careers, their lives, the economy, and the University. The other feeling was:
this is so daunting—I’m frozen. It was so scary. In July 2003, O’Donnell announced his
resignation, clearing the way for Zane, the first non -physician and female permanent CEO in
Tufts-NEMC’s history. Reaction from both industry pundits and employees at Tufts-NEMC
was uniformly positive. As one expert wrote: At this time and in this place, there is no one
better for the top job than Ellen Zane. The first non -physician chief executive, she comes
onboard at a time when tough decisions need to be made. Yes, she has the necessary
management skills, but she also has demonstrated a passionate commitment to preserving

the relationship that exists between physicians and patients and between this hospital and
the community it serves. 20 John Greenwood, VP of Finance, explained some of the things he
felt Zane brought to Tufts-NEMC: We lost our identity during the Lifespan merger. We also
lost touch with the Mayor’s office and Beacon Hill, 21 and making sure our concerns were
being heard. So when Ellen came on board, for the first few months we spent a lot of time on
Beacon Hill. She brought visibility and a very recognizable name in the market.
Accountability was also a big leadership trait that came on board with Ellen. She and the
consultants she brought in assisted the leadership in diagnosing what the issues and root
causes were, as well as prioritizing them. Then she held someone accountable for fixing it.
We’d done a lot of diagnosis before, so we h ad an idea of what the problems were, but Ellen
provided the leadership to drive the projects to completion. She also provided unity to the
physicians throughout the hospital. There used to be two autonomous physician
corporations with faculty/staff physicians. Both groups were completely separate. The first
year she came, Ellen pursued merging the two boards into one entity and eventually made it
happen. So now there is input and a synergy between the faculty at the hospital. They speak
with one voice. Michael Burke, senior vice president and CFO added: Ellen is so acutely
aware of what’s going on in the market—she’s been in this market her whole life, she built
PCHI. She knows all the players. She knows whom to call and she has the personal
relationships so that people are willing to work with her. Ellen is also the kind of person
who takes action. She gets 80 –90% of the information she needs and then she does
something. Most academic medical centers have what I call “analysis paralysis.” You can
accept the status quo, but the reality is things never stay the same—they either get better or
they get worse. And if you are not actively working to improve them, they will get worse.
This place was constantly assessing what to do, but not doing anything. And things got
worse, year after year after year. Now what we’re doing is assessing the data, assessing the
market, and acting, and doing, and getting things done. Diagnosis: Critical (2004) When
Zane came on board, she brought in a consulting group called BDC Advisors, Inc. They
gathered data to determine why Tufts-NEMC was losing an estimated $3 million a month.
Zane sat down with Schottland who gave her the bad news: Tufts-NEMC was not losing $3
million a month; since the split with Lifespan the number was closer to $6 million. Zane
recalled how the new reality changed her priorities: Although I had done a fair bit of due
diligence before taking the job, I was still shocked to find out that we didn’t have two years
of cash on hand: we had 10 months. So it changed everything overnight. Because strategy
was the last thing I could worry about—I had to worry about payroll. This place was
hemorrhaging millions every month. It was incredibly important to begin to think about
how to stabilize. Zane and BDC conducted what she called a “rapid diagnostic” to quickly
determine how to stem the losses. BDC concluded that, although Tufts-NEMC was on the
right path with Schottland’s initiatives, they were still behind industry benchmarks for
many areas, such as days in accounts receivable, accounts payable, average length of stay,
operating margin, and days cash on hand. There was also more savings to be had in the
supply chain (see Exhibit 11 for BDC analysis). After reviewing the managed care contracts,
Zane also realized that Tufts-NEMC was woefully underpaid. Another challenge for Tufts-
NEMC was its size. In any other market, Tufts-NEMC would be considered one of the biggest

players. But in Boston, it was dwarfed by Partners, CareGroup, and Caritas. Tufts-NEMC
fundraised $10 million in 2005, up from $5 million the year before but impossibly behind
the $200 million Partners raised. Tufts NEMC was the smallest teaching hospital in the
Boston area, but it was the primary teaching site for Tufts Medical School and was the 11 th
highest paid in NIH research funding. Underwriting that research cost Tufts-NEMC $15
million a year. Maintaining the level of services and research required for a major medical
center was extremely difficult for an organization without the volume of cases or
endowments enjoyed by its competitors. Zane realized early on that however difficult it may
be, it was absolutely crucial for Tu fts-NEMC to remain an AMC: We made a conscious
decision to keep funding research because we are an AMC with a tripartite mission, which
includes clinical excellence, research and teaching. If you take one of the legs off that stool
we are no longer an AMC and I would venture to say that no fewer than 80% of the doctors
who practice here would leave. They are here because they want to work in an AMC.
Treatment (2004–2006) Zane set to work on building her management team and reopening
the managed care contrac ts. Along with Schottland and BDC, she pushed hard on cost-
cutting and efficiency initiatives to bring Tufts-NEMC in line with industry best practices.
Zane continued plans to sell real estate in order to get the hospital on some solid financial
footing while giving these initiatives time to take hold. She also felt the need to re-establish
Tufts-NEMC’s brand in the Boston marketplace, to set about rebuilding affiliations and
networks, to reverse the trend of hospitals’ poaching Tufts-NEMC’s physicians, and to retain
the talent it had. Staff Changes Once Zane assessed the mission, she set about evaluating the
senior staff. She greatly appreciated the experience and expertise of people like Shottland
and Deeb Salem, Tufts-NEMC’s chief physician. But others she felt needed to be replaced.
Within two weeks she replaced the senior vice president of strategy with Deborah Joelson, a
network building expert who Zane recruited from Partners; and the vice president of
fundraising and development with Deb Taft, who had been extremely successful at the Dana
Farber/Jimmy Fund. In all, she replaced seven members —half of the senior management
team. Zane shared her thoughts on the senior staff turnover: One of the people I fired was a
favorite of one of the board members. I spent a lot of time listening to that board member
telling me that I had no right to fire his guy. But in the end he supported me. There was no
question that I had to do it. If you ask most people about me they will tell you I’m very good
at picking people. I really do believe that is a skill I have—it’s gut level for me. I’d like to get
credit for picking good people, not for a brilliant turnaround, strategies, or anything like
that. I’m only as good as the people around me, and I do pick great pe ople. I have a sixth
sense. I can tell when I go into the waiting room for interviews whether they have a shot.
For most of these characters here I knew it wasn’t going to happen. There were a couple of
other positions in the administrative round that I ch anged pretty fast. The COO Ed
Schottland was very solid. He was only here about 9 months. He came from Lifespan and I
am very grateful to this day that he was here and that he stayed. I would be toast without
him. Schottland added: It was chaos here before. I think it’s easy to disrupt the COO’s role,
especially in an organization this size. People used to go around the COO to the CEO—it
doesn’t take long before you are neutralized. Ellen has been very supportive of my role.
She’ll either say: “you really h ave to talk to Ed about that” or she’ll just have me in the room

when they talk to her. Now, most people in the organization don’t attempt to go around me.
I appreciate that . . . that’s important to me. Ellen’s let me continue to run the operations in
an appropriate way. We understand our roles and we know when to ask each other for help
and advice. Deb Taft, the new vice president for fundraising and development, talked about
why she joined Tufts -NEMC: If I could be a part of creating a fundraising department that
was vibrant and strong, this would be a career moment for me. I had people stopping me in
the street saying, “I can’t believe you are taking this job”. But what greater thing could there
be than helping this place survive? It deserves to be here. Keeping this place alive was
important enough for Ellen Zane not to retire. Ellen recognized that I had what she called
fire in the belly. That was her number one criteria in bringing me in. Communication and
Outreach Ellen is a remarkable communicator of good news and bad news. She was
somehow able to be fully transparent about what was going on and have people appreciate
that she was being honest with them about the situation. And no one felt that they had to
bail out of here because the p lace was going down the tubes. I don’t know how she did that.
—Deborah Joelson,senior vice president for market development and planning Very early
on, Zane led a series of “town meetings” where she presented financial facts, specifics on
new initiatives, and areas targeted for growth. Because the hospital worked around the
clock, Zane scheduled a series of meetings at various times throughout the day and night, to
ensure that everyone had a chance to attend. The meetings worked so well to disseminate
information that Zane continued to do them twice per year on all shifts. She also augmented
them with regular e-mails updating the staff and physicians on finances and other topics. As
Deeb Salem, TuftsNEMC’s chief physician explained: The things that she and Ed do are quite
remarkable. Periodically they have town meetings for the entire staff. They go out of their
way to talk to everybody, even the housekeeping staff. They have sessions in the middle of
the night so they can talk to the night shift. Taft agreed: Ellen does the town meetings in
every shift, and she wants the senior staff and VPs there because every shift matters. I’ve
been at employee parties and holiday parties helping her serve dessert from midnight to
two a.m., and we’ve brought desserts to the emergency department when they are so busy
they can’t get there. Ellen greets people and introduces herself and says “thanks for
coming.” That is a big thing for an employee who’s never met the CEO. So the staff starts to
feel like she belongs to them. She laughs and says she gets more e-mails from the staff than
anybody. But the fact is, she does. Zane explained what she saw as the benefits of the town
meeting format: I did a lot of town meetings. I was new. I had to get to know employees and
I had to t ell them what was going on. I put up this chart, which turned out to be a wonderful
chart. It had all the losses this place experienced during the Lifespan era. The $40 million
loss in 96, the $20 million loss in 97. Loss after loss after loss after loss. That adds up to
$250 million. I threw the chart up at my first board meeting. I threw it up at the Board. And I
said a lot of people have got egg on their face. That’s what I said to my Board. I used the
same chart with the employees. Then after those town meetings—to my utter shock—I
would come back to my office and I would have 20 e-mails from employees who had been
sitting in the audience and they were saying thank you. It was so incredible. People would
say: “I want to help. I knew something was wrong but no one was ever honest enough.” It
was really encouraging. And that was the pearl I learned—that you can tell people bad

news. But you have to do it in such a way that you are viewed as being honest, open,
credible, and consistent. Zane explained that the culture of Tufts-NEMC made it easier for
her to effect change: The one thing about this place that is so fabulous—that I can take no
credit for—is that it has a different, better, unique culture. I had been used to the Harvard
culture where there was all this bravado and testiness. This culture is much warmer, much
more collegial, much more cooperative. And I call it an “Avis—we try harder culture.” I tell
them: “Guys, we have to go left,” and they say “ok.” At Partners you’d need a committee and
two yea rs to get a decision. Maybe it’s because this place is smaller, I don’t know. I’ve never,
ever worked in a place, where employees who’ve been there for decades, physicians who’ve
been here a long time, will spontaneously, unsolicited, come up to me and say “I love this
place. And I’m sorry to see what’s happened.” Even physicians who have left—and it
hemorrhaged doctors in the tough days—felt that way. I called up a lot of them and asked
them to have a cup of coffee with me and tell me why they left. All of them—to a person
said—I didn’t want to leave. Zane used a variety of mediums to get the word out and to
manage the turnaround effort. She held weekly senior staff meetings with Schottland, the
general counsel, the CFO, the vice president of external affairs, the vice president of
development, and the senior vice president for market development and planning. The
focus of the meetings was mostly external, with Schottland providing updates on internal
operations from his weekly meetings with the operational vice presidents, the CIO, the vice
presidents of clinical services, and the vice president of human resources. Zane also met
regularly with the board of trustees. She reached out to physicians in an attempt to both
spread her message for change and to reta in them in the face of active poaching from other
AMCs. She worked hard on both retention and recruitment. In 2005 she convinced three
neurosurgeons to move from Beth Israel Deaconess Medical Center to expand Tufts-NEMC’s
minimally invasive neurosurgery department. Schottland described the outreach that he
and Zane conducted to physicians: When Ellen came, she came with the reputation,
credibility, and ability to deliver a hopeful message that prompted people to change and
gave them more hope. One thing we’ve done since she came here that I’ve never done
anywhere else, is spend an incredible amount of time talking to physicians, both recruiting
and retaining them. Ellen leads that charge, although I spend a lot of time with her on it. It’s
one of our challenges being in Boston—it’s so hard to recruit from out of town—and
everyone is stealing from everyone else. The neurosurgery department was a great example
of an Ellen coup. She led the negotiations on recruiting those new doctors. Our group, which
was split between Beth Israel and Tufts-NEMC, announced that they wanted to consolidate
to a single hospital. We gave them a better deal and they are doing a great job here. They are
young and aggressive—great surgeons. Ellen is very good at recruitment and retention. She
knows it’s important. You can’t run a hospital without physicians and they are very
expensive to replace. A lot of hospitals have recruitment and retention programs, but most
times the doctors don’t get to talk to the CEO. This is a smaller and friendlier place in a lot of
ways. It’s not hard to get to Ellen or me. For physicians, that’s a big deal. To have access to
Ellen in particular is enticing for them, and she’s very good at talking to them. Not only did
Zane work with physician groups, she began a monthly tour of different wards in the
hospital to get in touch with patients and nurses. Salem explained: Once a month Ellen and I

tour a ward together and she speaks to patients. She’ll ask them: “How’s Tufts -NEMC
treating you? Why did you come here? What can we do better?” The patients who
understand it are shocked that the CEO is talking to them. She also learns from the patients
and the floor nurses. They see that she really cares because she’ll walk around their floor.
When she’s done touring, she’ll talk to the head nurse and say, “You guys are doing a great
job.” When you talk to the patients yourself, you get a whole new feel for things. We found
that a lot of people liked the intimacy at Tufts-NEMC as opposed to one of the larger
hospitals like Children’s. We’re thinking about how to use that fact in our marketing.
Another thing we learned was that a lot of people didn’t like the food here. So now the food
service is working to change the whole menu. Agenda for Change In 2004, Zane, Shottland,
and BDC initiated a second round of cost-cutting and efficiency plans designed to improve
Tufts-NEMC’s processes. It was called the Agenda for Change. Along with improving the
reimbursements, it included restructuring, and basic “blocking and tackling” as Zane called
it: Blocking and tackling means the day-to-day gritty operations. The eight areas we wanted
to improve were: length of stay, managed care contracts, accounts receivable, FTEs, supply
chain, real estate, ambulatory clinics, and research costs. We focused really hard on those
things. I think a lot of people in my job like the limelight —they want to give speeches. But
the fact is if your house isn’t in order, the limelight is fleeting. My first year here I resigned
from most of my boards, backed off from a lot of things. I had to stick to my knitting. At the
very beginning, I really hunkered down, and then I slowly started to come up for air. The
latter half of 2004 Joelson and Schottland, along with the vice president of human resources,
and the director of business planning, developed a restructuring plan. The plan created
eight product lines that were essentially business lines: cardiac, cancer, surgery, general
medicine, transplant, OB/GYN, pediatrics, psychiatry, and neurosciences. Every service in
the hospital was included in one of these product lines. This was different from the past,
when some services were left out of the product lines. As Schottland explained: It’s very
hard to be all things to all people. That is one of our greatest challenges programmatically
and financially. But, because we are committed to doing that, we really can’t afford to have
key constituents feeling they are unimportant. We can’t deliver care in transplants, for
example, without infectious disease or interna l medicine. The product lines here give
everyone an opportunity to have a forum to talk about their programs. It is also a way to
drive decision making down to the physicians and give people who deliver the service
control of that service. The chief of cardiology was the clinical head of the cardiac product
line, for example. He partnered with a clinical vice president—an administrator. Together,
they were responsible for developing and implementing annual business plans, with goals,
objectives, and budgets for the product line. The CFO and COO approved the budgets every
year and reviewed the business plans monthly. The business plans were the venues by
which decisions were made on investments in staff, facilities, infrastructure, and
technology. The plans d irected decisions regarding whether, and how much, to grow and
how to accomplish that growth. Some of the areas Tufts-NEMC hoped to grow were core
services, such as cardiac and cancer programs, pediatrics and maternal health, psychiatry,
bariatric/obesity surgery, and organ and bone marrow transplants. Support services such
as pharmacy, nursing units, and radiology, however, were outside the management

structure of product lines. Schottland explained why: A lot of hospitals have tried product
lines in different ways. One way is the matrix structure that we have and the other way is a
purer structure. We weren’t big enough to be pure. We can’t have a free -standing heart
hospital or cancer center. We can’t afford to never put a medical patient on the cardiac u nit.
If we don’t have a cardiac patient we need that bed to put someone else in. We have to have
the flexibility. So that’s why the product lines can’t control the nursing units. The head of
cardiac would want to keep those beds just for cardiac patients a nd we can’t afford to do
that. Length of Stay On the operations side, one of the most important cost-saving initiatives
was to reduce length of stay (LOS). The consultants that Zane brought in identified that
Tufts-NEMC was keeping patients a day and a half too long, compared to other AMCs. David
Fairchild, Tufts-NEMC’s new chief of general medicine, chaired the 30-person Care
Management Committee, which was charged with reducing LOS. Fairchild and his
committee set about educating the staff about the importance of reducing LOS, changing
attitudes about patient care, and attacking and identifying procedural failures called
“unnecessary delays” in various ways: • • • The team set up a special internal e-mail
address—LOS delays—where staff could send a complaint or description of an unnecessary
delay that impacted length of stay. This delivered useful information directly to hospital
leadership regarding causes of delays. The BDC consultants identified areas where Tufts-
NEMC could improve, such as use of tracheotomies and blood transfusions. Use of data,
which drilled down to individual physicians’ LOS statistics year over year, and presenting
that feedback to physicians frequently. One major issue that the e-mail address identified
was the use of “PICC lines”. PICC lines were more durable IV lines that allowed patients to
continue their medication at home. Specially trained nurses had to insert the PICC lines, and
many times the doctor discharged the patient too late in the day, and these nurses were not
available. Another problem with PICC lines arose when the nurse was unable to insert the
line and needed fluoroscopy to aid the insertion. In the old system, the nurse informed the
doctor that the PICC line was unsuccessful, then the doctor arranged for the patient to go to
the fluoroscopy suite. Doctors conducted teaching rounds between 10:30 a.m. and 1 p.m., so
if the nurse was unable to insert the PICC line, the patient often had to wait until the next
day for the fluoroscopy suite to become available. Fairchild and his committee came up with
new procedures to remedy the situation. They required doctors to make decisions on
discharges before they went on teaching rounds and they gave the nurses who inserted
PICC lines the authorization to send patients directly to fluoroscopy if the PICC line could
not be inserted by the nurse. Within a year of raising awareness and using more efficient
procedures, the committee was able to reduce LOS by a full day, saving Tufts-NEMC $2
million per year. Fairchild explained how Zane’s leadership helped with the LOS project:
Ellen brought a sense of urgency. She and the consultants identified a few key initiatives.
One was the contracting initiative that she was heading, and another was reduction in
length of stay for hospitalized patien ts. Ellen brought a compelling vision supported by
compelling data for where we needed to go. One of the most compelling pieces of data was a
graph showing our LOS compared to all our competitor hospitals. We were an outlier, above
the line by a day and ha lf! A one-day reduction in the average length of stay across our
hospital is worth millions of dollars. I took that graph around to every department meeting I

attended. After that it was just a matter of identifying what was causing the delays. There
was a lmost no resistance to changing procedures, since everyone understood that length of
stay was crucial to financial turn-around, and that financial improvement was the first step
toward fulfilling the vision for the future of NEMC. That is where good leadership came in.
Contract Negotiations The hospital had just completed a round of contract negotiations with
insurers when Zane joined Tufts -NEMC. She realized how critical it would be to
immediately increase rates, so she went to the major health plans and a sked them to
reopen negotiations. Zane discussed her talks with the insurance companies: Because I
went toe-to-toe with the insurance companies when I was at Partners, I was afraid they
would think “it’s payback time” since I no longer had the same leverage. To my utter delight
none of them did that. They all had the attitude that it wasn’t personal, it was a business
decision. My argument to them about why Tufts -NEMC should get higher rates was simple.
I said to them, “look if you guys want the strong to get stronger and the weak to get weaker,
then don’t open these contracts. But if you want competition in this market, you need to
open these contracts.” And they did. It wasn’t a cakewalk, they didn’t just write me a check.
We fought about it. But the truth is they all stepped up to the plate and I will always be
grateful to Blue Cross, Harvard Pilgrim, and Tufts. The improvements in the contracts were
absolutely critical to the financial bottom line. As Shottland explained: After Ellen arrived,
we discovered that we were getting paid really poorly. We improved our reimbursement by
$20–$25 million. That was the missing piece. That’s what brought us from where we were,
which was a $10 million loss, to actually making some money last year. That was Ellen’s
guid ance and leadership that did that. Network Building Zane went to work bringing back
the affiliations and networks Tufts-NEMC had lost in the past. By October of 2004 the
hospital announced plans to affiliate with Children’s Hospital in order to augment the
services of the Floating Hospital for Children, which was fragile and had lost sufficient scale
over many years of neglect and poor management. Zane was able to move quickly on
affiliation agreements, not allowing deals to get bogged down in red tape. Deborah Joelson,
senior vice president for market development and planning, related one example of this:
One of the first things I had on my desk when I arrived here was an affiliation agreement
with a community hospital. I finished negotiating the deal and went to Ellen and said, “Ok
we have an agreement.” She said “Great, let’s do it.” I said, “What, just sign it? No
committees? No … nothing?” At Partners, an agreement like that would take months, if not
years, if it were ever to get done, because of all the internal constituencies that needed to
approve everything. It was just a lot more complicated. So I always laugh when I think that
she said “just do it, trust your instincts and just go ahead.” With the sense of urgency and
lack of resources that we have here, we don’t have the time to spend noodling over every
little decision. A year later, Tufts-NEMC won a major coup when they affiliated with Primary
Care, LLC (PCLLC) 22 one of the state’s oldest and largest primary care independent
networks. The new network became part of Tufts -NEMC and was called New England
Quality Care Alliance (NEQCA). Zane recruited Jeffrey La sker, the former chairman of the
Partners physician network to run it. PCLLC had for nine years negotiated contracts (a large
percentage of which were Medicare risk products, such as Secure Horizons) for its 164
physicians, which served 500,000 patients. T he group felt that they needed to become

affiliated with an AMC and sent out a proposal request to systems in the Boston area.
Joelson recalled how Tufts-NEMC closed that deal, when every other hospital was vying for
the practice: We had almost no network, and few people to manage the network we had. We
didn’t have the infrastructure here to deal with payer contracts. That had been done at
Lifespan. The PCLLC physicians wanted a seat at the table —that was most important to
them. We saw an opportunity to integrate PCLLCs infrastructure into Tufts-NEMC, and not
only give them a place at the table, but make them a table. We created an organization,
NEQCA, that they ran, that provided something to Tufts-NEMC that we didn’t have. This is
also an example of where Ellen is so good. If you need her at a meeting she goes. We literally
met every week for two months with PCLLC and Ellen was there every week to meet with
them. Quite frankly I don’t think many CEOs would have sat down once a week to make this
happ en. She is willing to get her hands dirty, but she’s a leader when she does. She doesn’t
micro manage the process, but she makes herself available and it’s clear to everyone that
this is important and that it matters to her. Working With Tufts University Zane cultivated a
close working relationship with Bacow and Michael Rosenblatt, the new dean of Tufts
Medical School. She recognized the importance of the hospital and the University to each
other. She sat on the board of overseers for the medical school and worked to build joint
initiatives in research and fundraising. As Zane described: It is very famous in AMC cultures
that Deans and hospital CEOs don’t get along. There is usually a tremendous amount of
tension. One of the things I’m proudest of —and I think the Dean would say this too—is that
we get along extremely well. He started his job three weeks before I started mine, neither of
us own a lot of the problems here or at the medical school so we started with a clean slate.
The relationship is so strong between us. We have now developed a joint fundraising plan.
We’re better together than apart. That gives Larry Bacow a great deal of pleasure. He really
is vested in Mike’s success and mine. Taft explained the disconnect that Tufts-NEMC had
with Tufts University in the past: Some years ago, Tufts-NEMC actually took the Tufts name
off of its signs and logos. That was a big mistake. They were not building the Tufts name, or
building that relationship. In a Harvard medical town, Tufts -NEMC was not leveraging one
of the top trump cards they had: the terrific and growing reputation of Tufts University,
their nutrition school, medical, dental, veterinary schools. So they had all of that at Tufts-
NEMC, and it wasn’t being leveraged. In the real estate arena, Tufts-NEMC held many
buildings on and around the Tufts University campus on Kneeland Street in Chinatown.
When Tufts-NEMC decided to sell one building it made sense for the University to purchase
it. In one local business journal, Zane explained her thinking: If you drive down Huntington
Avenue, you know when you’re at Northeastern University. When you’re at Commonwealth
Avenue, you know you’re at Boston University. But if you drive down Kneeland Street into
Chinatown, you don’t know you’re at Tufts. You don’t get the feeling you’re in an urban
campus.23 The University and Tufts-NEMC were in the “preliminary stage of looking at how
to make the area more like a traditional urban university campus. The university held ‘town
meetings’ to discuss the issues and is hiring planners to develop possible scenarios” the
magazine reported. 24 Prognosis: Short- and Long-Term Outlook Leadership is about
what’s next. A lot of initiatives were started before Ellen got here, but she added the ext ra
“umph” to make it happen. Now it’s about what is next. What is the strategy. We’re still a

small hospital, we’re still challenged every day because of our size to meet the financial
basics to succeed. – Ed Schottland, COO In 2006, with her leadership team established, the
sale of a building to Tufts University for $28 million adding needed capital, cost savings
initiatives in place and improved managed care contracts, Zane was starting to move to the
next phase, building a strategy for the future. Zane and her team were working with the
Board in a major strategic planning initiative. In addition, Joelson was doing marketing
research, the first Tufts-NEMC had conducted in years. They were trying to answer
questions such as: • • • • What scale should Tufts-NEMC be? How can we best market
ourselves? How can we differentiate ourselves in the marketplace? What is the best way to
work with community hospitals and physicians? As Joelson explained: We are trying to
create an alternative. Our goal is to be big enough to have the scale we need to operate
efficiently and to be able to provide sufficient sub- specialties to be an academic medical
center—the principle teaching hospital of Tufts University School of Medicine. We don’t
want to be as big or expensive as Partners. We have 3% market share; Partners has 25%
market share. We’re at best a 400 -bed hospital; Partners has 2,000 beds. We see ourselves
as a network of some physicians and some community hospitals, and as a lower cost
alternative in the market. We can be effective with the new pay for performance contracts.
It is more efficient and less expensive to keep the care local, so our strategy is to try to move
the care that can be moved to community hospitals where we have relationships. On the
marketing side, we are implementing what we call an anti-invisibility advertising campaign.
Our market research determined we had no identity in the market. We also learned that we
were a house of individual brands — the doctors—rather than a brand in itself. As a result,
we are building a physician-to-physician marketing campaign, using NEQCA as the starting
point. We also plan to grow NEQCA from 600 to 1,000 doctors by 2010. Perhaps the biggest
plan to come out of the strategic initiative was the partnership with New England Baptist
Hospital, another Tufts Medical School affiliated teaching hospital, to build a new 190-bed
hospital in the Boston suburbs. If the plan came to fruition, it would be the first hospital
built in Massachusetts in 25 years. Although the site had not yet been selected, Zane was
quoted as saying that: In the past, hospitals have asked people in the suburbs to come to
them and pay more for parking than the co -pay on their health insurance. Our view is:
Wouldn’t it be a good idea to take sophisticated academic medicine and bring it to the
people? 25 This type of bold planning gave the employees at Tufts-NEMC confidence about
the future. Deeb Salem gave his viewpoint on where the hospital stood in mid -2006: I’ve
never been more optimistic. There are still a lot of problems. But the main source of anxiety
is what happens if Ellen decides to leave. That’s the problem having somebody that good.
We’ve seen how well she runs things. But with her in charge I do have a lot of hope. Zane
finally saw the light at the end of the tunnel she had entered in January 2004, but she knew
that her work had only just begun. She needed to find a way to keep the staff on track for
the turnaround. She needed improved efficiency and cash flows to keep wind in the sails in
order to move the rudder in the right direction. She also knew that Tufts-NEMC was far
from a safe harbor: I have lots of friends at Partner’s—but business is business—if they
could steal my best bone marrow transplant surgeon they would. It’s the way it is. That is
the deal. I can’t let down my guard for a minute. I am able, now, to spend much more of my

time on stra tegy, on the future, on where this place is going. That is, frankly, why I took the
job. I didn’t come here to pull down accounts receivable, I came here to do something to
position this place for the future. • • Resources: Responsibility Charting and AIDA
Continuum Chart Complete Change Plan Grading Guide Develop a Complete Change Plan for
a change initiative that you want to make happen. Use facts from the case study scenario
that your team selected in Week 4. The team may add no more than three facts or
characters, or a combination of facts or characters to the case study to assist in fleshing out
the development of the Complete Change Plan. Use your team’s top selected strategy for the
change initiative as well as the statement of the need for change and your vision for the
change developed in Week 4. • • • • • • • • • • • • Write a 1,400- to 1,750-word detailed
Complete Change Plan. The Complete Change Plan will be broken into the following four
parts: The Action Steps What are the critical steps that must be accomplished? Arrange your
action steps in sequence. Can some be done simultaneously? What activities cannot begin or
should not start until others are completed? What timelines should you observe? It is often
useful to begin at the end of the project and work your way backward. Who needs to
become committed to the project? Where are key players at on the adoption continuum?
Are they even aware of the change? If aware, are they interested or have they moved
beyond that stage to either desiring action or having already adopted? What will it take to
move them along the continuum in the direction of adoption? Use the AIDA Continuum
chart and include this chart in your plan. What is the commitment to the adoption of those
who have reached the adopter stage? That is, are they at the “let it happen” stage, the “help
it happen” stage, or the “make it happen” stage? Use the Responsibility Chart and include
this chart in your plan. Who will do what, where, when, and how? Often a responsibility
chart can be useful to track these things. Contingency Planning What are the critical
decision points? Who makes those decisions? What should be done if the decision or event
does not go as planned? What plans can be made to account for these contingencies? If you
can, draw a decision tree of the action plan and lay out the decision-event sequence.
Measurement of Change How will it be determined that the goal or change project has been
successfully implemented? At times, success will be obvious (e.g., a new system in place). At
other times, success will be more difficult to measure (e.g., attitudes toward the adoption
and acceptance of a new system). What intermediate signals will indicate that progress is
being made? What is the first step or sequence of steps? • • • • Transition Strategy
Formulate a transition strategy that includes a communications proposal. How will the
transition be managed? Who will make the innumerable decisions required to handle the
details? Who will provide information to those affected? How will the change be
communicated to organizational members? Use organizational change terminology
consistent with what is used in your text. Use a minimum of four sources in addition to
Organizational Change text. Format the assignment consistent with APA guidelines.

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