UT Medical Center CEO Joe Landsman retires after 25 years of unrelenting growth

How do you account for your career?

Most people tally the promotions and pay raises, the years stacked up one upon the other.

Joe Landsman isn't most people. He's got a background in accounting, but that's like saying Tom Brady played a little football. Joe Landsman counts everything.

Landsman retires April 1 as president of the University of Tennessee Medical Center, handing over that title to Dr. Keith Gray, who took on Landsman's CEO duties on July 1 as part of a long and carefully planned transition.

As Landsman concludes a quarter century at UTMC, almost all in charge, he was happy to spend two hours last month with Knox News to add up the medical center's accomplishments dating back to his arrival in 1999.

So let's count with him, but go in realizing the numbers add up fast and in staggering leaps.

Here's a few, just to start.

• UTMC's bed count has increased from 384 to 710.

• Surgeries have increased from 19,576 to 32,651.

• Patient admissions have increased from 22,073 to 35,528.

• Emergency department visits have increased from 50,767 to 86,242.

• Revenue has increased from $260 million to $1.432 billion. That's billion with a "b" and a mind-bending 451% increase during his tenure (I rounded that percentage, and I guarantee you Landsman knew it before he got to this parenthetical).

Landsman did this with a help of a management team whose core stayed together through most of those 25 years, and he's fast to mention them and does so frequently. He'll tell you himself more about his leadership team when we get into the Q&A in just a bit, but for the purposes of trying to sum up a career of dizzying scope, I'm going to keep the focus on him first.

Landsman added clinics and regional health centers, expanding UTMC's footprint well beyond the Knoxville campus throughout East Tennessee.

He renovated or expanded or added everything from day surgery to new transplant surgical intensive care units.

He constructed parking garage after parking garage to accommodate all the cars coming to campus, and put helicopters into the skies to whirl the most gravely injured to emergency care with the utmost speed.

And as Landsman piled up the bricks and mortar, he laid the foundation for what's become a rigorous academic medical center that encompasses 10 academic departments, 11 residency programs and 17 fellowship programs. There are 239 residents and fellows at UTMC drawn to Knoxville by the opportunity and ambition laid out by Landsman and his leadership team.

And then there are the awards (so much more to count): Blue Cross Blue Shield Distinction Center+ honors for cardiac care and spine surgery and knee and hip replacement and bariatric surgery and maternity care. Magnet Destination distinctions three times. A Tennessee Center for Performance Excellence award. Many Forbes lists: Best Employers, Best Employers by State, Best Midsize Employers. Best Hospitals recognition from Money magazine. The U.S. News and World Report rankings: first in Knoxville 10 years in a row, top three in Tennessee 10 years in a row and nationally ranked twice.

That's his favorite milestone among them all, the day U.S. News and World Report named the University of Tennessee Medical Center one of the best hospitals in America. It was July 19, 2012. Joe Landsman's birthday.

He's had a lot of time to reflect as he prepares to leave UTMC (but not fully retire, no way). He knows he hasn't always been the easiest person to work with or found the straightest path to success. He knows he made mistakes and he knows how much he owes to so many people whose names won't make it into this piece because we've got word counts we've got to respect.

Landsman knows this, too, unshakably, as he prepares to walk out of his office for the last time: His relentless striving for excellence, he said as we stood up after our interview, "that's part of my DNA, and now it's part of the hospital's DNA."

This is Knox News' conversation with Landsman, lightly edited for length and clarity.

Knox News: What was your initial reaction when you first saw Knoxville and considered it as a place you might settle?

Landsman: So I was in Dallas, and I lived in big cities all my life, in Baltimore, Washington, Dallas. I spent some time in Norfolk, which is nice, but really mostly the big cities. And I was just I was looking for a smaller area, a more community-minded area to live.

I had a job offer I was about ready to accept in Chicago as CFO of Rush-Presbyterian-St. Luke's. I was talking to one of the doctors and he said, 'You're gonna love it up here – the lake gets warm enough to swim in about one month out of the year,' and I thought, 'You're not helping.'

So anyway, I was within a week of having to give them an answer and (UTMC's) recruiter found me. They flew to Dallas to make the job offer, I mean it was like a week between my first interview and the time I got the offer, and this was exactly what I was looking for, someplace I felt like you're going to have an impact. A good place to live with good people, community-minded folks.

If you look at any vibrant economic community, you've got a few underpinnings. Your key foundational items that are a good health care system, good educational system and a good workforce. And it's going to have at least one academic medical center.

The campus looked good, but not great. I loved the doctors – I met with a bunch of doctors in the interviewing process and really liked their attitude. The board members were really, really good people. You're talking about people like Bernie Bernstein and Bill Rukeyser and Jim Haslam and Bill Sansom. I mean, we had Joe Johnson.

At the time we were the smallest of four health systems and the third-largest hospital. So in a very challenging market. But I felt like we had a good opportunity separating from the university and establishing our dedicated governance structure. It really was a great opportunity to do something unique and something to really, really benefit the community.

And so that's why.

Knox News: When you first started working in health care, did you have an idea what your career path was going to look like? If you were sitting there at 28 or 30 years old and saw where you are today, would you be surprised by that?

Landsman: So I got into health care very deliberately, but I was also very fortunate. I spent a year working for a big brokerage firm in Maryland. And I was with Arthur Andersen for a very, very brief period of time. And they decided, as a corporation, that health care was going to be one of their big industries. And they were really going to focus on it and I got invited to join their health care group.

And so you know, it was a very deliberate decision on my part. I was very fortunate to have those opportunities offered to me and then second, I celebrate opportunity and that's why I ended up in health care and then after leaving Anderson, a lot of work on my health care clients.

And then in Dallas, I ended up being the executive vice president (at Zale Lipshy University Hospital) . They were preparing me to consider to take over as CEO, but I thought, "What else, though? It was a great place but I left there because I did not want to be a CEO. I don't want these headaches, right? And then, five years later, here I am again.

Knox News: There's such a different skill set in running an organization that provides health care, right? There's a mission to the work. And you've got to think strategically in a way that's not other people's job. How do you bridge those conversations and create a vision for people who are on the ground?

Landsman: From my vantage point, leaders don't live in the here and now they've got to live 10 to 15 years out and they've got to believe. If you don't believe you can get there. And one of the things I tell my team all the time is that our future is only limited by our own vision of ourselves.

So, one of the things that I talk about is we can achieve anything we set out to achieve and I'm and we have, every time we set a goal, we've achieved it. But it takes discipline. It takes attention, effort, energy. And so you also have to break it down and turn it into steps people can understand and can personalize. This is my role in helping us achieve our goals as an organization.

I was really blessed with a very stable team. I think once I was six months into the CEO job, I didn't lose those senior level executives other than retirements and we did have one person pass away due to illness. A 20-year run with the same team, it's pretty meaningful. I lost my my last two senior executives to retirement last April. So it's been a very stable team.

Knox News: Describe some of the biggest challenges you and your leadership team took on.

Landsman: (Before the 2008 presidential election) we were looking at the Affordable Care Act and how it would be crafted. And that was a time of incredible insecurity in our industry. You know, our executives were all insecure about it, not knowing what the future was. Or physicians were very insecure and concerned about their future based on what they were hearing and reading about.

And it really wasn't about the act. There were really good parts of the act. And so I just actually sat at my kitchen table and said, look, first of all, one of the problems in our industry is we've never had a period of stability. It's been chaos for us, and we're always having to respond to various and sundry changes in the way we reimburse. And so we've been diverted from really paying attention to our product, which is health care services, and the value of that product. I sat at my kitchen table when we can just kind of wrote this out thought about the history in my career.

And it occurred to me that it wasn't about the reimbursement system, we got it backwards. It's about the product we deliver. And we had lots of opportunity to do better as an industry.

And so we got laser-focused on how we were going to improve our product and focus on the value of our product. And the people that receive our product. They're our employers. They're our payers, and they're our patients. So we looked how can we be providing good value product for these three customers?

We started with a three-step journey. We needed a framework.

I broke up my vice presidents and senior vice presidents into five groups, and I sent them around the country. I sent them to Mayo, to Cleveland Clinic, to Hopkins, to Vanderbilt. Each of the teams came back and wrote a white paper about how this those organizations evolved and got to where they are today.

We first targeted being a magnet facility, and it's all about nursing. It's a very rigorous set of standards you have to demonstrate that you're you're complying with. But the reason we chose magnet first was nurses or nursing enterprises is about a third of our workforce. And if you mobilize your third of your workforce around a big, common hard-to-achieve goal you change your whole culture. And at he same time, we were starting to reinvest in our facility and upgrade the look and feel of our facility and everybody got excited about it. So we achieved magnet.

And then we moved on to the Tennessee Center for performance excellence. And again, it was about the framework and about mobilizing the facility and making them believe we can achieve this. And we did. We achieved the highest-level award, which was the Excellence Award from the Tennessee Center for Performance Excellence.

And now we're going to go and we're continuing our Baldrige journey (a national private-public partnership dedicated to improving U.S. businesses – just 28 hospitals have received a Baldridge Award dating back to 2002) . And it's really, it's not about the awards. It's not about the recognition. It's about the the discipline and the format, the structure that those programs provide you to help you improve.

Knox News: You have spent tremendous effort on creating pathways for treatment, standard practices to improve health care outcomes (UTMC has hundreds of DRGs, or diagnostic research guides, to elevate patient care by using proven techniques that are rigorously conceived, tested and adjusted as medicine advances) . How is that successful?

Landsman: We've learned from other industries. Use Campbell's Soup, as an example. I don't care if you buy it in California or Tennessee, it's going to look the same, it will be packaged the same, it will taste the same. It's the recipe.

(In medicine), if you have a knee replacement, if you go to several different places you're going to have a different implant, a different blade, a different recovery period. Everything is different. There's no reason for that. Now, there are anomalies that make you change the way you approach certain patients. But again, it's the 80/20 rule. You know, 80% of our patients will do great under standardized practice.

The experts say it still takes 17 years in the United States to fully adopt evidence-based medicine. There's still about a third of inefficiency in our system, which means there's about a third of waste, excess costs. And we have lots of opportunities to improve the patient experience.

And so just went out with that vision. And to the medical staff's credit, they bought into it immediately. They physicians built the pathways. They measure them. They monitor them themselves. The look at deviations to make sure they're appropriate. That's driven our quality. If we do this work, and we have the highest quality, safest product product, we have the best experience of those receiving and delivering the product, and we do everything as efficiently and effectively as we can.

There are times when you deviate from your standard practice, particularly when you're dealing with human beings, but 80% of our patients follow this standardized practice. That's, by the way, evidence-based, developed by the clinicians that are caring for the patient. So it's the doctors and some nurses and pharmacists, physical therapists, radiologists, they're all building their standardized practice, we call pathways. If the physician feels like they need to deviate for some reason, they can deviate. But if there's no reason to deviate, don't deviate.

We created the four big measures (mortality, complications, unplanned readmissions, length of stay). And we've been measuring those ever since we created them (around 2008). And we measure each one of our pathways, which there are now about 300. We measure all four of those metrics for those pathways. And we compare it to a peer group that hospitals like us and we want to be better.

Knox News: You've had a career at UTMC that's spanned a quarter century, big changes in health care reimbursement, the COVID crisis and a huge expansion in the facilities that have made UTMC a recognized model for an academic medical center. What is your legacy?

Landsman: When I look back, I think first of all, changing the culture and the team that lives our culture every day. I would consider that my team's biggest legacy. I say my team, it's not just me.

And then you look at the fulfillment of the commitment to being an academic medical center community. That's the growth in the educational programs I'm talking about, particularly the fellowship program. And you know, neurology neurologists are hard to recruit and hard to find for patients to get into because there's so few and we are making application as we speak for new residency programs in neurology.

We take our mission very seriously. We've invested in that mission.

There's a great story and we stabilized and started to perform well as and organization and a business. We turned our attention to make sure that everyone in this region has an opportunity to live their best life and be the healthiest they can be. And we'll continue to do that work.

Joe Landsman, stability and the story of UTMC's growth

The photos of the University of Tennessee Medical Center tell a story of pride and potential. The caption on one from July 1956 describes the brand-new hospital.

"The six-story, $6,000,000 citadel of medicine in which research, teaching and training will have equal importance, is shown above on the Alcoa Highway site overlooking the Tennessee River across from the U-T farm campus buildings. The building's 245,000 square feet make it the University's largest single structure."

Nearly 70 years later, the massive UTMC campus would boggle the minds of those ambitious founders.

The growth was not foreordained. In 2019, Hahnemann University Hospital, the teaching hospital of Drexel University College of Medicine, closed amid a financial crisis that shocked the medical community. The hospital was established in 1885, and when it closed, nearly 600 physicians who were residents or fellows were displaced, and Philadelphia lost a vital Level 1 trauma center.

The closure was presaged by a revolving door of top executives at Hahnemann in the years before it collapsed. Five CEOs cycled through the organization in a single year.

So to understand the growth of UTMC from a single hospital to a nationally recognized academic medical center that boasts 10 academic departments, 11 residency programs and 17 fellowship programs, one needs to start with stability.

And another way to spell stability is Joe Landsman.

Landsman retires as UTMC president April 1, capping a quarter century in top leadership, including as president and CEO before he handed off the position of CEO to his successor, Dr. Keith Gray, in anticipation of retirement. Remarkable among leadership at most medical organizations, Landsman retained a core team throughout his tenure.

Together they pushed and pulled and cajoled and convinced and demanded and directed the people who are the institution. The results are both physical and conceptual. They are concrete (literally). They are cultural.

Landsman lands heavily on the last when I asked him to reflect on his legacy. "When I look back, I think first of all, changing the culture and the team that lives our culture every day,"

Our cover story today is a package that focuses on the major milestones of Landsman leadership at UTMC. I don't know that I've ever felt the limitations of the physical space of the newspaper as acutely as I did in this effort. To try to distill the work of a career as substantial as Landsman's would take a book, no exaggeration.

What shone through in two hours of conversation that could easily have stretched for two more was his consuming passion for the place he chose to serve for so long and his pride in the people who helped build the University of Tennessee Medical Center into an anchor for our community.

Landsman has an easy manner in conversation and his explanations bounce seamlessly between illuminating anecdotes and impeccable detail. I never worked with him, but I imagine there were elements of both in his leadership style.

"We went," Landsman told me, "on a very deliberate journey."

What Joe Landsman's work means to the community

I had the privilege to work with Joe for nearly 20 years while I was leading Covenant Health. While we were competitors, our common challenges provided us with more opportunities to collaborate as colleagues than to compete.

We had similar nonprofit missions to serve our communities by providing high quality health care to all.

I always found Joe, as the leader of the region's academic medical center, to have an absolute commitment to quality. Joe was knowledgeable about national healthcare policy issues and the unique regional issues like TennCare and some of the lowest Medicare reimbursement in the country, which made leading a successful health care system in the Knoxville region particularly challenging.

The success and growth of UT Medical Center in this environment is a credit to his consistent leadership and vision.

– Tony Speiza, former CEO of Covenant Health

The words “transformational leader” are often overused, but Joe stands out as the epitome of one.

He has truly transformed UT Medical Center to now being a regional and state leader in health care. His greatest legacy may be the talent and leadership he developed that will now lead the institution to even higher levels.

– Randy Boyd, president, University of Tennessee System

Joe has led and inspired a period of tremendous growth for the medical center – leading with a can-do spirit and ability to instill confidence in his leadership team, physicians and our thousands of team members.

His leadership has helped us achieve an incredible transformation of the medical center over the past 25 years, and his many contributions have enabled us to better serve our community as the region's academic health system.

Joe has rewritten the medical center's history and set the stage for its continued growth and progress toward our mission, vision and values."

– Renda Burkhart, board chair, University of Tennessee Medical Center/University Health Services

When Joe Landsman became CEO of UT Medical Center in 2005, it was a good hospital.

But he leaves it as a truly great hospital.

Congratulations to him.

– James A. Haslam III, founder of Pilot Corporation and former board member of the University of Tennessee Trustees and University of Tennessee Foundation

Joel Christopher is the executive editor. Email: joel.christopher@knoxnews.com

This article originally appeared on Knoxville News Sentinel: University of Tennessee Medical Center CEO Joe Landsman retires