Todd:
Welcome back to the podcast. We have a very special guest today, Steve Purves, who is the president and CEO of Valleywise Health. Steve, welcome.
Steve Purves:
Delighted to be here, Todd.
Todd:
It's interesting we were both saying that. I guess we both had the same thought today that it is been quite a long time since we first met, but feels like just yesterday.
Steve Purves:
It does. No, I remember coming into Phoenix and you were one of the first people I actually met when I was getting to know the community, so it seems like yesterday.
Todd:
Absolutely. Well, there's a lot to talk about, a lot of water, of course, under the bridge, but maybe for folks who don't know you, talk a little bit about yourself. Tell us something about yourself, the work that you're doing and maybe something that we wouldn't know that's not on your bio.
Steve Purves:
Well, sure. I'll start by saying I'm the product of an army family. I grew up as an army brat, which means that you move around a lot. And so when I was a kid, it was about every two years where you were a new kid coming into a new situation. And that formed me as a person and a little bit of my personality and a little bit about assimilating into a new community. So there's some things that I took away from that. So I grew up in an army family and we moved around all over the place. I graduated from high school in Germany when we were stationed over there and I went to college up in Springfield, Massachusetts, mainly to play football. My football coach went up there and that's all I wanted to do at the time.
Todd:
Of course.
Steve Purves:
Probably a little misguided, but in any event, and then I went to grad school in San Antonio, Texas, but I've had a very long and rewarding career in healthcare, 43+ years now and been in seven different states and have enjoyed every second of it, but healthcare has been a long-term passion of mine. And so that's a little bit about my upbringing. I could go on and on about other, this, that and the other things, but I'm sure we'll have time.
Todd:
Sure. And something about you that maybe we wouldn't know that's not on your resume.
Steve Purves:
Okay. So I've had lots of hobbies growing up. I was a competitive table tennis player back in my day along with the other sports I was involved in and ended up having the opportunity to be a coach for Saudi National Junior Table Tennis Team back in the '70s. And matter of fact, I taught them, took them up to the '76 Olympics and not as participants, but as observers. And so that's probably something that you wouldn't know.
Todd:
I love that. How's your game today?
Steve Purves:
Probably nonexistent, but no, it's a great sport and anybody who follows it really gets amazed at the agility and the technical aspects of it.
Todd:
It really is. I'm not good at this. So obviously, healthcare is a huge passion, 43 years, but anything in life careers, they're not linear. How did you get there?
Steve Purves:
Well, I was very focused in college. Once I figured out, "Look, I wasn't going to be in Doug Flutie or anything ...
Todd:
"They weren't calling."
Steve Purves:
... I was one of the smallest guys on my football team. I was the quarterback, but I blew my knee out in between my sophomore and my junior year. I was playing racquetball of all things and I tore my ACL. This was 1976, so back in those days, it was a very long open involved procedure. They didn't have arthroscopic surgery programs as we do today, not near the technology. So when I was looking at my options, I decided to go ahead and just rehab my knee and forego the operative procedure. And I've done well on it, so it got me focused. The whole point of that is that it got me focused into what I wanted to do next.
And so I got busy, really had a passion for healthcare. I wanted to do something in the health sciences. I wasn't sure what, but I really, really loved the entrepreneurial part of healthcare and the business side of healthcare. And so I really latched on to healthcare administration, ended up doing an internship in a hospital and loved that environment. Some people love it, some people don't. I loved it. And so from that point on, I was very focused in terms of getting as much experience as I possibly could. So I did an administrative internship in a hospital in my home state of Virginia and learned a lot. I learned that you better listen to the nursing supervisor in the hospital if you really want to be successful in healthcare and got to know how a hospital works.
I got to know the different jobs in the hospital, which is amazing, the number and types of skillsets that you need to run a health system. Everything from the environmental services piece of it to the hospitality hotel part of it to the clinical side of giving healthcare. So from there, I was very fortunate to get into graduate school and then did my administrative residency for a year. And then right from there, I moved right into the hospital field, started out in the investor-owned hospital industry. I was with HCA back in the early years, back when the investor-owned industry really started burgeoning. So I cut my teeth on the operations there and then moved over into the not-for-profit and the academic, the teaching hospitals and then eventually into the public teaching hospitals, which is how we're organized at Valleywise Health today.
Todd:
You bet. To think about the way we plan our lives and the fact that we have racquetball to thank for having you here is pretty interesting and I'm sure your coach was not pleased that you were playing racquetball when you shouldn't have.
Steve Purves:
Yeah, I was a little bummed. I was a little bummed out on that, but it got my head straight though, I think.
Todd:
I'm sure your parents were not unhappy about that and we're certainly lucky that you're here. Maybe what would be good for folks who aren't necessarily familiar with Valleywise, talk a little bit about what is it and who do you serve?
Steve Purves:
Thanks. It's my favorite subject. Okay, so we go back a long time. We were here and started up in 1877 and so-
Todd:
Before we were a state.
Steve Purves:
Yeah, for all the history buffs out there, Arizona became a state in 1912. So we were here as part of the Arizona territory and we were formed because a group of committed and concerned residents of the territory that felt that there needed to be a place to serve the sick, the suffering and the dying. Even though back in those days we didn't know much about the communicable diseases that we had facing us. We didn't have the technology. We certainly didn't understand mental healthcare. And so it was a place, unfortunately, for people with maladies to be quarantined. And they had terrible names for hospitals back in those days, sanitarium and houses of pestilence and all those kinds of things, but we were formed because of need in the community.
And so when you fast forward to the unbelievable rich history that the county hospital has had over those years, we've always had the same mission. We've had different names, we've had different mission statements, but the mission and the vision has always been the same. And so we were part of the county for many years. We reorganized by vote of the public, referendum to create an independent special healthcare district with an independent board, but still very much public. We're accountable to the public that we serve. And so that was back the first year of operations, I think, as an independent special healthcare district was in 2004.
There were certain milestones along the way including being Arizona's one of the early and first teaching hospitals in 1952 when we started up that mission. And today, we consider it a core mission of ours. It is central to our being.
Todd:
Well, central for Arizona.
Steve Purves:
Well, it's an important public asset for Arizonans. And the Arizona Burn Center was formed in 1962 and that has become the second largest burn program in the United States. And today with opening of the new medical center here very shortly, it will absolutely be the most sophisticated, the most patient-centric and most technologically advanced burn program, I will say in the United States, but if it's the best in the United States, it'll be the best in the world. So we're very, very proud of that. So we are very much a public safety net system of care. We've always been a safety net for underserved populations, for vulnerable populations in our community and we do that through a variety of different ways, not the least of which is our network of federally qualified health centers that are in underserved areas, a focus on mental healthcare, which we've significantly expanded over the years and also through the typical kinds of programs and services you might expect a public teaching hospital to have like a trauma program and the burn center and all the things that go with it.
So plenty of milestones. In 2014, the voters approved a $935 million bond referendum through Proposition 480 that allowed us the ability to literally reinvent an entire public healthcare system and teaching hospitals with a new medical center, new clinics, expanded behavioral health centers, etcetera. It's really a once-in-a-lifetime opportunity to be able to literally create a brand new system, which we call Care Reimagined. We had, and you may want to get into this too, but we had a few issues financially back in the 2013, 2014 when we lost a major supplemental funding source and we had to dig ourselves out of about a $85 million hole. And so fortunately, we were able to do that and then move forward with the construction on our facilities.
Todd:
Well, an interesting thinking about that, for those of us who've just been here for a little bit, we remember, for instance, the whole facility. And I don't think, like we said, "Well, it'd be nice to have something newer." It was functionally obsolete. You couldn't really do the work that you were trying to do regardless. Is that how you saw it?
Steve Purves:
Absolutely. Things didn't work right. The facility didn't enable a lot of high-quality, state-of-the-art care. It wasn't built for a clinical learning environment. And so when we started the planning process for the new medical center, we decided it wasn't just going to be a bricks-and-mortar project. It was going to be literally a reinvention our care processes, so that the care processes to enable things like a state-of-the-art intensive care unit. Our old ICUs, when I stepped foot inside Valleywise Health, or at the time Maricopa Integrated Health System, I couldn't believe the ICUs that we had. I hadn't seen those since the '70s.
Todd:
They were that outdated.
Steve Purves:
And there were no walls between the rooms. There were curtains. It was crowded. There was no space. And so we had the opportunity to create something that was not only conducive to patient care, but also better for the patients and better for families and their loved ones that are concerned about their patients. So it was literally a top-to-bottom revamp of our health system. And so that's something that again is a once-in-a-lifetime opportunity.
Todd:
And you had your work cut out for you right when you got here?
Steve Purves:
I did.
Todd:
Maybe for folks who don't know or are uninitiated, the difference between a public entity that is Valleywise and a traditional hospital system?
Steve Purves:
Sure. Hospitals are organized in a variety of different ways throughout our country. There are investor-owned hospitals that are supported by private investors. Some are publicly traded companies, some are private. And they have served a very important role in our nation over many years in terms of the expansion and the capital that was required to build new hospitals and especially in areas where perhaps there wasn't a hospital. There was a program called the Hill-Burton Act that provided funding and then Medicare came into being in the '60s and that provided the capital and the reimbursement that these investor-owned systems needed to expand across the country.
So you have the investor-owned. Then you have private, not-for-profit organizations that exist with mostly self-perpetuating boards that come from the community that they're usually organized as a 501(c)(3) organization with a community mission.
Todd:
Charitable function.
Steve Purves:
Absolutely. They have a charitable mission. They have to use their earnings to fulfill their mission and to plow back into the institution rather than to a portion of which going to private investors, for example. Most of the health systems here in Arizona and certainly the ones in Phoenix are private 501(C)(3) organizations. We do have investor-owned organizations as well, Abrazo which is part of Tenet comes to mind. We're unique because we're the only public hospital. And usually, the difference there really goes back to the purpose that you fulfill in the community. And so when you are predominantly serving Medicaid and uninsured patients, the financing mechanisms that exist in our country today aren't sufficient to maintain that mission.
So when we're 50% Medicaid and 20% uninsured and commercially insured patients are very small and Medicare is medium to low, that doesn't provide the reimbursement on your contracts with third-party payers and what you can charge to cover your cost. And so that mission basically is set first and then what follows from that is how you're organized. And so most public hospitals are created by either counties or states, state government or county governments. Some of them are directly operated by counties. Some of them are special healthcare districts set up like we are. There's a variety of different ways to set those up.
Most of the time, they're supported by public financial support, either through tax levy of maintenance and operations. And most of them have to rely on the generosity of the public for their strategic capital because we don't generate enough internal capital or internal earnings to sock away, to receive the bond ratings that we need to have access to capital like the investor owns. So we're definitely accountable to the public. Our board meetings are open to the public and our board is elected by the five districts within Maricopa County and they're accountable to the public for that.
Todd:
And that's an interesting for you to have to manage that process. I'm sure it's interesting and we'll get to that in a minute. What I do want to go back to is something you mentioned, and in fact, that prior to even having this new model of care, we still had arguably the best burn center in the country and to your point, probably the world. How? How is that asset part of really a public hospital, really incredible?
Steve Purves:
Well, first, it came from commitment. Talent and commitment. It is an unbelievably complicated set of both technology and expertise that you need to have to provide burn care. So it starts with all of that. Burn programs are a role of the dice, believe you me. Financially, you could have one or two cases, uninsured cases, and basically, it would consume your entire budget for a year. Some of these patients will stay months and months, some more than a year. And so the financial aspects of running a burn center is very challenging at best. So it fits pretty well under a public hospital operation where there is some subsidy to help shoulder the uncompensated care that's generated as a result of that, but it was commitment.
At the end of the day, it was support, commitment. There were visionary physicians that really wanted to make sure that we had that service available for a wide swath of geography here in the southwest. And so in '62, that started and it's been supported ever since.
Todd:
Such a point of pride for us, and certainly, we know Officer Schechterle and the fact that he will tell everybody, "They saved my life and gave me my life back," but so many other people as well have been impacted by that burn center. I understand, with the new care model, you're also implementing something that probably hasn't been done before related to PTSD after a burn, a severe burn.
Steve Purves:
Yeah. The new burn center was designed very comprehensively, so it really centers on the patient and their family through the entire continuum of their care. The old facility, we didn't have the space to have rehabilitative services, for example. We didn't have dedicated spaces for the pediatric population that had been burned. We didn't have near enough space for the teaching aspect of what we do and we certainly didn't have services that are needed in concert with burn care like hyperbaric oxygen therapy, for example. We didn't have spaces for that. And so because of the generosity of the public through Prop 480, but also private philanthropy, we've been able to build the state-of-the-art center that's comprehensive, that was the dream of our physicians and nurses that work in burn care over many, many years and they're just thrilled to be able to watch this vision come to fruition.
Todd:
Absolutely. I know we're going to be taking our board to see everything that's new and I encourage others to do the same. Let's now focus on ... You're in a very unique role, even from a hospital administration standpoint. Tell us a little bit about what that looks like and what's your leadership style?
Steve Purves:
Sure. So I've seen just about every governance structure that you can see, okay? So at the end of the day, hospitals are organized differently. They have their unique challenges. For example, having a private self-perpetuating board has different challenges than a publicly elected board of directors. But above all else, I think that you have to make sure that everybody that you work with understands who you are and you have to make sure that your principles, which I've garnered over many, many years, I've plagiarized some of them, I've had mentors along the way that have believed in me and taught me a lot, I've made a ton of mistakes, especially early in my career that you hope you fix before it's too late, but you really have to understand who you are as a person and understand your principles. And then everybody else has to understand what the expectations are.
You have to be extraordinarily transparent in our field. You have to be, above all else, a person that has unwavering values, high character. Your ethics and your character have to be above reproach. And if you don't enjoy working with people, you will not stay in healthcare very long. So in terms of working with boards, I think, first off, one of my principles that has served me well, especially since I've been in public hospitals, is have empathy and respect for publicly elected officials. Now, they have fiduciary responsibility, they're accountable to the public and you have to make sure that you are providing them with every device to be successful at fulfilling their fiduciary role.
There can never be surprises. So that open, honest, two-way communication has to be absolutely the way of doing business and the way of life for you when you're working with a lot of stakeholders. So in terms of your senior leadership team, being the best person on the team is not nearly as important or as meaningful as being the best person for the team.
Todd:
Interesting distinction.
Steve Purves:
Yes. And so you really have to make sure that, as a team, that there is a true north that everybody pulls in concert with and that it is absolutely okay, and as a matter of fact, expected to have differences of opinion from time to time because that's what makes better decisions. And so we've spent a lot of time ... I've spent a lot of time over my career just making sure that there was a good team-based environment for us to get things done, to get the job done. Being able to articulate a mission, a vision and a strategy is imperative for a CEO to do. And by the way, you can have the best strategy in the world, but if your culture is not great, you know what they say? Culture eats strategy for lunch. But it's true. And by the way, if you can't execute a strategy ... Who said execution was 90% of strategy? Which it probably is. You have to be able to execute.
So all those things don't happen by themselves. You have to have a method. Hope is not a strategy. You have to have the method to put into place for that. And so when you're building teams, you just have to make sure that everybody sees that true north. So in terms of vision, strategy and execution, we used to have ... By the way, our mission hasn't changed since 1877. We are absolutely proud of our county origins, our public origins. We are extremely proud of that. And just because we changed our name to Valleywise Health doesn't mean that any of that has changed. We carry that very proudly. The rationale for the Valleywise health change was, "Look, if we're going to reinvent an entire healthcare system, then we need a way to communicate that change in a very easy way."
Valleywise is very simple. Maricopa integrated health system is a mouthful, okay? No disrespect at all for that name. Proud of it, proud of the origins. People will call us county forever and we're proud of that. That's okay. That's okay. Valleywise Health is a way to talk about, frankly, a new American public healthcare system and system of care teaching hospital. It's the chassis that we think all public health systems ought to be built around. And so we're proud of that and we want to share that. So our mission statement is really simple. It's to provide exceptional care without exception every patient, every time.
Todd:
Well, clearly you're a very thoughtful and articulate leader and that's why you have, I think, such a good leadership team. Where does failure play in your leadership model?
Steve Purves:
Failure is part of life. Just learn from your mistakes. It's okay to fail, just don't do it every day. Learn. Learn from that. Take those failures and put it to use. I got to tell you, I've taken some lessons learned from my younger junior executive days that thank goodness I paid attention to because I wouldn't be here today if I behaved like that.
Todd:
So it's an important tool as long as you learn.
Steve Purves:
Right.
Todd:
So let's pivot. Clearly, you got here and immediately had to deal with the financial crisis and got through that, but then you basically restructured the whole system. What are some of the challenges going forward?
Steve Purves:
So yes. So just to reflect a little bit on the financial turnaround that we had, we got down to single digits days cash on hand. Literally, we were in danger of missing payroll. And I'll tell you, nothing focuses the mind like missing payroll.
Todd:
Absolutely.
Steve Purves:
So we didn't have a lot of time. So right after Prop 480 was passed in November of '14, I knew that we weren't going to be able to start the construction because we ... I mean, imagine, okay, great, we have all these wonderful buildings, but if you can't afford to staff it or operate it, what's the use, okay? So we got the team offsite and we just put that cash graph there and we projected when we would be below zero, which is D-Day basically in a bad way. That's when we missed payroll. And so I didn't have time to bring in a big eight accounting firm and have them tell us what we already know and then give us a thick report and said, "Oh, by the way, for a couple million dollars, we will help you implement this." We didn't do it.
So we started what I call the leadership development approach to margin improvement. And we assessed readiness for change in our organization and the results were not surprising. There was a great readiness for change in our organization. If you don't have readiness for change from leaders, I don't care what you do, it's not going to be successful.
Todd:
Were your staff there too, below leadership? Because a lot of times, there's a resistance, there's the keepers of the past. Was some of that there?
Steve Purves:
Oh, sure. Every organization has their things about culture that ... And by the way, the challenge with respect to culture is to understand what about your culture that has existed for many years is accretive to your being and your organization and your goodwill in the community and keep that and get rid of the stuff that's held you back. Easier said than done, but that's what you have to do. So we started, yes, we had some resistance in the organization, but what happened was is that we got teams from all over our health system. We found that we were fairly siloed, we were fairly walled off and that happens in a lot of great organizations, but it usually results in bad things.
So what we did was we got folks out of the departments, created teams and I gave them each leader in our organization and these teams one key metric per 100-day cycle. And I said, "I want every manager to come up with eight ideas to either improve quality, reduce cost or generate revenue."
Todd:
So you threw out the playbook with one metric.
Steve Purves:
Eight metrics per manager per a hundred days. You know how many ideas that generates? Okay, so those ideas come in, most of them are absolutely ... Some of them are funny, some of them are ridiculous, some of them ... But guess what? If 10% of those ideas stick and we validate those margin improvement results from that idea, oh my gosh, millions of dollars start coming in the door as a result of those ideas. And we celebrated the crazy ideas, just like we celebrated the great ideas, because again, the metric was the idea generation and we did a very rapid approach to implementation. We did what we call rapid cycle testing because there's nothing worse in an organization as this slow no.
When somebody comes up with an idea and they floated up the chain and they don't hear about it for a year and then somebody ask a question, "What happened to that idea that I asked about," "Oh, we decided not to do that," and they say, "Thanks. I wish I'd have known that. I'd have stopped worrying about it." So we got rid of the slow no and we rapidly implemented things. And so long story short, in a three-year period, we had north of $150-$160 million financial turnaround, which if we hadn't had done that, then the pandemic would've been our demise. We needed that.
Todd:
Yeah, you didn't know that was coming.
Steve Purves:
No, we didn't know that was coming. So fast forward today, we've had some of those same financial challenges coming out of the effects of the pandemic that we had.
Todd:
Yeah, well, interesting and you're right, cash is king. When you saw that day's cash on hand, you're right, that focuses people immediately. But kudos on getting the right team together to lead your way out of that and listening to your people, I'm sure, from a cultural perspective that made a difference. So one of the things that I'd like to also focus on and ask you about, aside from the burn units, the focus on behavioral health. Clearly, after the pandemic especially, we're seeing such an uptick in challenges relating to behavioral health and treating. Give us a sense for your role in that space.
Steve Purves:
Sure. So when we envisioned Care Reimagined or Proposition 480, a central part of that was to really make sure that we significantly expanded our footprint for the care of the seriously mentally ill population. And not just that, but to develop some innovative ambulatory outpatient programs designed to keep young people in particular, but to keep people from being institutionalized and working with families to actually do that. And so we've innovated some very important programs for the community, like our First Episode Center and our Assertive Community Treatment teams that work for families and young people for that.
But we knew that we were going to need some resources in order to pull that off. And so here we had a situation where we were trying to figure out within the dollars that we had with Prop 480, "How in the world were we going to do that?" So what happened was and we saw an opportunity to acquire the Maryvale Hospital when it was shuttered and we probably saved north of $100 million not having to build a brand new facility from the ground up. So we took that hospital, we retrofitted it, we turned it into a behavioral health hospital, but we maintained the emergency department that was there, that was serving 40,000 people a year that was getting ready to close.
Todd:
It's such a big asset.
Steve Purves:
Yeah. And so we said, "Hey, there's a huge need there," and that's what drove us the need. Now financially, again, challenges, but we were committed to keeping that service open for the community and then also to convert that hospital into a behavioral health facility. Between that facility and our other two, the one on the Roosevelt campus and then the one in Mesa that we've got, we have today about 420 inpatient beds. It's actually more licensed beds than we have on the acute side of our health system, which makes us pretty unique in terms of public hospital systems.
So then beyond that, it was a matter of the staffing and the pandemic did two things to hurt our ability to stand up the capacity. One was, when you have infection, COVID infections, you have to quarantine patients and so you have to take those beds out of service and you can't move those patients into the general populations. That restricted our ability to open up those beds. And then the labor situation that happened through the pandemic was challenging. And so we didn't have near enough behavioral health technicians and registered nurses to open up our beds. I'm happy to tell you through some really great support that we've received from the state and the county to support our workforce, we've put that to use and we're setting records for our inpatient census right now for the seriously millennial population, which again, opens up a bottleneck that extends to emergency departments, to the emergency crisis centers and then into the inpatient setting.
Todd:
Absolutely. Anybody who's trying to find a bed for a mental healthcare patient, it's a very difficult thing. Well, I want to go back a little bit to COVID first to thank you. You and your peers were literally on the frontline in a life and death battle during COVID. What were some of the things you learned from that?
Steve Purves:
Well, that don't think you know everything and don't pretend like everything. That's for sure, but we learned a lot through the pandemic in terms of how to care for these patients. We stood up a telehealth program like in a week and something that we'd been trying to do for years, but because of barriers that existed in our healthcare system, it was next to impossible to really stand up a robust telehealth program. But we did that within a week and that was the difference between access to healthcare or no access to healthcare for hundreds of thousands of patients that we serve in the ambulatory setting. So that was something that we certainly learned.
I also learned how effective and powerful collaboration between the health systems was and not just for managing a pandemic, but for all kinds of different things. We have wonderful collaboration within Arizona and particularly here in Phoenix when we're dealing with community problems. And so that is something that it was heartwarming to see how effective our chief clinical officers, our chief medical officers worked together. They were literally together multiple times a week trying to coordinate resources and making sure that there was capacity in the community for the large influx of COVID patients. So that was another learning.
We also learned basically how stressful it was on our workforce. As administrators, we felt helpless and wondering, "What the heck could we do to support our clinicians?" And so we, at Valleywise and a number of hospitals, we did whatever we could as suits. We signed up for what we called rover shifts where we were out on the nursing units and whether it was answering call bells or fetching supplies or just whatever we could do to be helpful and not in the way of our nurses and our physicians. And I learned a lot by spending time in an intensive care unit with a group of nurses about really what they care about, some of their particular challenges, etcetera.
And so it really was a learning experience beyond just the clinical care of the patients, but it was really understanding just what absolute jewels we have and people who choose to serve others in the profession of healthcare. It is amazing to me. I get inspired every single day by that. And it's no wonder that every year that, when the Gallup surveys come out, the number one person on the top of the list of most trusted professions, most respected professions is healthcare and mostly it's nurses. So anyway, we've learned a lot.
Todd:
Absolutely. I give you credit for not basically staying behind a desk and getting out there. And you're right, we all did feel helpless, but you certainly were such an important role, had such an important role in your capacity to make sure that we got through the pandemic. So when you mentioned collaborations, how important is our collaborations from the community or business to Valleywise today?
Steve Purves:
Look, we couldn't be more proud or pleased at the community support that we have. And it's really across the board, across the aisle. It's bipartisan. We're so very, very grateful for that, but we never, never ever take it for granted As a public asset. We are constantly searching for ways to improve quality of life for Arizonians. If you really boil it down to what the purpose of a public health system, big picture is to prove quality of life. How do we do that? Well, we do it through a variety of ways. One way is to bring more healthcare learners into the state of Arizona. And so we're constantly searching for end of ways to do that, which resulted in our partnership with Creighton University and our friends at St. Joseph's Hospital and our medical faculty to create this academic partnership for the purpose of bringing more learners in the state.
That was the catalyst for Creighton University to build a new medical school here. And we had a goal between now and 2025 to bring 900 new learners, healthcare learners into the state. We're well on track for that because we don't rank very well in terms of physicians per a hundred thousand population. Frankly, nurses and other categories, we don't rank very well and so-
Todd:
And our population's not going down.
Steve Purves:
It's not going down. It's one of the fastest growing populations in the country. And so in any event, we focus a lot in terms of what we do on how we improve quality of life by addressing access to healthcare, which workforce is extraordinarily important. So our clinical learning environment is important. The other ways we do that is to be good stewards of our resources. I told my team, when we were having our financial problems, because there were some that said, "Hey, you just need more supplemental funding, Steve. You just need to go over to the governor's office and have them come up with a bigger pot of money for it."
Todd:
Money or check.
Steve Purves:
I said, "Hold on a minute. Show me how we stack up with respect to our revenue cycle, how efficient it is. What about our supply chain? What about our productivity? What about our quality metrics?" And if I don't have a good story to tell, if I were the governor, I would say, "Mr. Purves, I want you to get yourself back over to your own institution, fix your own problems before you look government for a handout."
Todd:
Absolutely.
Steve Purves:
And so we had to fix our issue. So being good stewards of taxpayers' resources is extremely important. And it goes beyond the commitment that you make just on a day-to-day basis of just daily operations of a hospital. You always have to keep that stewardship in mind. And then you have to grow with the need. What compels us for growth is not taking somebody's market share. What compels us for growth is where is the need in the community. So when we planned our new ambulatory care centers, our federally qualified health centers, we use as the primary planning metric where the concentration of Medicaid population exists, which is a proxy for underserved areas and we wanted to make sure that we had a community health center located within about a 15-minute transportation time to 90-plus percent of the population in Maricopa County.
And we've largely accomplished that, but there's still need out there and we still have a lot more to do to extend that access to healthcare, to vulnerable populations. And so at the end of the day, we appreciate the community support. We've never done anything by ourselves, ever. We've relied on the generosity of the public. The Valleywise Health Foundation has grown exponentially over the last five years and we're getting significant philanthropic support. And I would argue, if somebody asked me, "Well, why do you need to get donations to the public if you're a tax-supported organization? Hold on. If you're a taxpayer and you've got that little line on your property tax notice that says Maricopa County Special Healthcare District, then you're going to say, 'Okay, what are they doing to reduce the reliance on that?'"
One way is philanthropy. And if we're not focused on that piece of it, then I would ask somebody to ask me, "Why in the world are you just not taking that opportunity because it's an additional revenue source?" And matter of fact, every single that we receive from philanthropy goes straight to the bottom line. Every dollar of patient service revenue, you got all your contractual deductions that come out of it, the uncompensated care that comes out of it. You're lucky if you put $2 billion of gross revenue on the top line. You're lucky to generate maybe 800-900 million in net revenue. So that's the importance and the effectiveness of healthcare philanthropy.
And so I'm really, really pleased at the growth of foundation, but I think in order to garner and to continue to garner that support, I think we have to give high-quality care, we have to continue to serve unmet needs, and we have to be great stewards of our resources.
Todd:
No doubt. For those folks that are listening that would like to look at perhaps contributing to the foundation, where can they get more information?
Steve Purves:
valleywisehealthfoundation.org, just go on that website and they make it very easy for you to give.
Todd:
I'll make sure you do that. Your dollars are going to be well spent. As we wrap up here, Steve, looking around the corner, you're obviously a leader with a vision and I'm sure you've planned this up. What can we expect? What's around the corner for Valleywise and for you?
Steve Purves:
So strategic planning never stops. It never stops. We are already in the process of looking at what's the next iteration, because we know the minute we open up our new medical center, we're going to be at capacity. The growth of the community is hard to keep up with. It really, really is. We planned this project with growth estimates back over 10 years ago. And so we're already [inaudible 00:46:12]. We got to figure out how we address that. There's also more need for community health centers to serve vulnerable populations. We're going to have to continue to focus on behavioral healthcare. And then we're going to have to address probably one of the top strategic issues in healthcare and that's parking.
Todd:
That's everybody.
Steve Purves:
So in terms of our campus, so you'll eventually see the old hospital be demolished and that there'll be ... We need to clear that campus off for our future master facilities plan. So the planning never, never stops.
Todd:
Well, it's good that you're there and you're so visionary and we're going to keep this success going. Thank you for taking so much time with us today. We're going to wrap up with a quick lightning round. We're going to jump out of healthcare. We're going to go back to Steve. What was your first job, not professional, just your first job?
Steve Purves:
For actual first job ever?
Todd:
Yeah.
Steve Purves:
Ever, ever? Cleaning apartments.
Todd:
What did you learn?
Steve Purves:
When I was in high school. I learned that, if I want to keep from having to do that every day, that I best keep my grades up and get an education.
Todd:
Absolutely. Well, job done. First car? What was your first car?
Steve Purves:
A 1966 Ford Fairlane, two-door.
Todd:
Oh, nice. All right, that holds some appeal still. And then finally, first concert?
Steve Purves:
First concert. I think I know what it was. It was Iron Butterfly. That was actually in between. It was Chicago and Iron Butterfly the same summer.
Todd:
Okay, so you had them both there. Those are respectable. Those are good. I like that. Well, Steve, thanks again. Thanks for everything you're doing and certainly like to have you back once everything's opened up at the center and have an opportunity to come and take a look and see how we can further support you.
Steve Purves:
Thank you, Todd. Appreciate the opportunity.
Todd:
Great.