Cee-Eye-Eee-Eye-Ohh: Farmer at heart Robert Earley cultivates a culture of caring and competence at Tarrant County’s public-supported health care system.

Robert Earley

Nov. 16, 2014 – the day Robert Earley fell through the attic of his house and ended up in John Peter Smith Hospital’s ICU with a severe head injury – was, he says, the third best day of his life, behind only the day he married his wife, Trish, and the day his daughter, Bryce, was born.

Two months later, the day the president and CEO of JPS Health Network unexpectedly returned to work for his monthly Leadership Connection meeting – dancing the macarena with his head bandaged in green bubble wrap – was perhaps the best day ever in the life of Tarrant County’s publicly supported health care system.

Rumors had circulated that the fractured skull and brain bleed that kept Earley in his trauma center’s ICU for three days might prevent him from ever getting back to work full time at full speed, might prevent him from ever walking again.

People closest to JPS credit the hospital system’s new and much improved performance and reputation to its charismatic administrator. There was concern that the whole turnaround of JPS Health Network was in jeopardy along with the CEO’s life.

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But the bubble wrap, and a short video he produced to introduce his surprise arrival at the meeting, convinced everyone that he would not only survive but would fully recover with his confidence, keen intellect and wit intact.

It was a very good day for JPS.

Personal Lesson

For Earley, the head injury was a good thing, he says, because it gave him profound insight into what sick and frightened and injured people need and want when they are dazed, confused and often alone.

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“Becoming a patient at JPS taught me what it’s really like to suddenly be very ill and dependent and helpless,” Earley told Fort Worth Business CEO. “You are in the most vulnerable place you can be. My life was literally in other people’s hands, totally.”

He learned that when someone is very ill, “You want the hands touching you to be warm and kind and give comfort,” Earley said during our recent visit in his small office at the sprawling hospital.

“I did not always know what was going on, but I remember one nurse, Sarah, taking my hand and telling me, ‘I think things are going to be just fine.’ I think back on that and realize that for some patients that sweet, beautiful nurse may be the only visitor they have all day. How many of our patients don’t have the family support that I have? We have an obligation to make their hospital experience the best it can be, under whatever circumstances.”

And, Earley says, he was really glad that, with a severe head injury, he was at JPS.

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“I knew it was the best place I could be in the entire area with a head injury. I was so thankful to be exactly where I was, and I want all our patients to feel exactly the same way,” he said. “You never know, you could fall through your ceiling tomorrow.”

Personal Touch

Earley was appointed interim CEO in 2008 and officially named president and CEO of JPS Health Network in 2009. He is known for things such as making rounds at the hospital with a large entourage of executive staffers every Friday – similar to medical rounds – and making follow-up phone calls to dozens of recently discharged patients chosen at random every week “just to check on how we are doing and what we could do better,” he says.

He asks questions such as, “Are you OK? Do you have any questions? Was the food OK? Did you have enough blankets? Is there anything I can do to make your day better?”

Earley says “rounding” is the highlight of his week because he gets to go into patients’ rooms and talk to them one-on-one.

Earley guides a team of more than 6,000 employees, physicians and contractors who encounter 1.1 million patients a year at either the 537-bed acute-care hospital in near south Fort Worth or one of JPS Health Network’s 42 primary, specialty and school-based health care centers and clinics throughout Tarrant County.

He admits he knew nothing about hospital administration when he joined JPS in 2005 as senior vice president for public affairs and advocacy. He did not complete his master’s degree in health care administration from the University of Texas at Arlington until August 2009 – six months after he became president and CEO of the $850 million taxpayer-supported health care system, one of Tarrant County’s 10 largest employers.

But he has succeeded in transforming JPS from an overcrowded, poorly maintained facility with an unhappy staff and mistrust among its doctors, nurses, administrators, other hospitals, the hospital district board of managers and county commissioners into a system that makes every effort to instill pride in all Tarrant County residents.

The Docs Take Notice

“The difference is ‘Earley and team’ does not always tell you what you want to hear, but he’s always honest and trustworthy and interested in getting us what we need to provide better care for our patients,” said Dr. Travis Motley, who specializes in foot and ankle surgery at JPS.

“In the past, there have been some problems between physicians and administration. We never worked together. Now, it’s what can we do that’s reasonable and within our budget to provide better care for our patients. We may not get everything we want, but this administration has allowed us as physicians and surgeons to right our ship and run our ship in a way that puts patients first, and that’s a departure from the past,” Motley said.

Today’s spirit of respect and cooperation – among doctors and administrators, town and gown, MDs and DOs, public and private hospitals, nursing students and medical students, residents and physician specialists – can be attributed to mutual efforts to put patients first.

“In health care, there are so many factors that can get between the patient and the caregivers,” said Dr. Michael Williams, president of UNT Health Science Center. “Robert and I are both trying to build cultures where the patient comes first and is at the center of the health care team.”

Dr. James Johnson, an anesthesiologist and vice president of the JPS medical staff, says it was clear when he interviewed for the medical staff several years ago that Earley had taken over and had a vision that put the patients of Tarrant County at its center.

“He was most interested in what we could do to offer all of Tarrant County top notch, presidential care, and I wanted to be part of that,” Johnson said. “From my perspective his vision is all centered on patient care with the premise that if you center on the patient, everything else follows. Every decision is put in the context of what’s best for our patients.

“When you go into medicine, it all starts with wanting to help people. You may get beat up a little along the way, but when you find a team that brings you back to why you went into medicine in the first place, you just take so much pride in it,” Johnson said in a telephone interview.

Simple Rules

How has Earley managed to turn things around?

“I put people around me who are smarter than I am, really talented people. I ask them ‘Now, what do we do?’ and I really listen and think about their answers before I decide anything,” he says. “If, as CEO, you think you know all the answers, you really limit yourself.”

Earley governs by a simple set of rules, and he expects every employee to know the rules and be happy about them.

“Robert’s Rules” are:

– Own it.

– Seek joy.

– Don’t be a jerk.

“It’s an amazing thing. Our people are hard-wired to be pleasant, enjoy their work and follow Robert’s rules,” says J.R. Labbe, vice president for communications and community affairs at JPS Health Network. “They don’t all know our mission statement, but they all know Robert’s rules.”

“Own it” means take pride in where you are and what you are doing because you own this place. If you see something wrong or broken or problematic, fix it, Earley says. Treat JPS like it’s a new car that you just bought, not like an old one that you are renting with no desire to ever own.

“Seek joy” means look for reasons to be happy. Smile and let those around you – patients and co-workers – know that you are glad to be at JPS working with them.

“You spend a lot of time at work. If you don’t want to be here or you don’t like working here with our patients, then you should go somewhere else,” Earley says with a simple shrug.

And “Don’t be a jerk” is self-explanatory, he points out. “Jerks are mean-spirited, and I just don’t like mean people.”

Earley has a reputation for shaking hands, hugging and exchanging high fives with patients and staff, personally handing out turkeys or fruit baskets to every employee during the holidays, flipping pancakes for hours during the pancake breakfasts he hosts and generously recognizing and rewarding good deeds.

He is hugely into thank-you cards and he baked pies for the trauma team when he got out of ICU last year.

“Now I’m baking pies for the pharmacy team, and there are about 150 people in pharmacy so it’s taking a while,” he said during our recent visit to his farm. “It’s just fun. I’m not sure my pies are all that good, but if you’ve been on a 12-hour shift in the ER and I bring you a pie that I just baked, it makes you smile.”

Farmer at Heart

Four large Clydesdale horses are among the things that make Earley smile.

He was there in the stable when the first two of them were born, marveling at how their graceful, 2,000-pound mothers danced carefully around the fragile foals, and he says he gets up every day at 5:15 a.m. to clean their stalls, brush them, feed them and just rub up against the gentle giants.

He has trained them to patiently pose in show stances for halter class competition and is teaching them to work in harnesses and collars to pull a cart. “The boys,” as he calls them, have won their share of ribbons at various state fairs, and this fall Earley is taking two of them to the 2015 World Clydesdale Show in London, Ontario, Canada.

“Trish taught Hamish [their first-born Clydesdale] to give kisses,” Earley brags of his wife. “My horses, my daughter and my wife are my world when I’m not at the hospital working.”

Earley’s world includes the home he and his wife planned and built, a hay barn, carriage house and the horse barn on 65 acres surrounded by split-rail cedar fencing on Little Mary’s Creek in southwest Tarrant County.

His wife is a veterinarian who treats small animals, mostly dogs and cats. He says he’s a farmer at heart, and the horses bring him an incredible amount of joy.

He also makes cheese, harvests honey from an estimated 40,000 bees that live in two hives his wife gave him for his 40th birthday and chops wood when he wants to clear his head and focus on the moment.

“That’s how he works things out,” Trish Earley says. “I always know when he has a lot to work through by the amount of wood he chops.”

Political Child

An unconventional hospital CEO, Earley graduated from the University of North Texas with a degree in political science in 1983 and promptly went to Washington, D.C., to serve on the staff of U.S. Rep. Tom Vandergriff.

After a year in Washington, at the age of 23, he moved back to South Texas to his hometown of Portland to run for a seat in the Texas House of Representatives and launch a career in public service.

“My ambition was always to be in public office,” he says. “When I was a 9-year-old kid, I would divide up my friends into teams as Democrats and Republicans.”

Earley was elected to Texas House District 33 representing the geographic region between Corpus Christi and San Antonio for five terms. He says his 10 years in the Legislature were “wonderful,” but the pay was only $425 a month, and he was also working as a ranch hand for $800 a month plus room and board when the Legislature wasn’t in session.

At 23, that was exactly what he wanted to do, but at 33 he was starting to think about getting married and starting a family. He chose not to run for a sixth term.

When he left the Legislature, Earley accepted a faculty position at Texas A&M University, where he taught ethics for three years and met his wife-to-be, who was a veterinary student. He then moved back to Austin, where he organized his own public affairs firm, served as political analyst for KXAN television, the Austin NBC affiliate, and taught at St. Edward’s University.

Cutting Wait Time

When Earley was appointed CEO in 2009, JPS had a new, larger emergency center that served about 175 patients a day, but 21 percent of those who showed up for medical care were leaving the ER untreated, primarily because of long waits, confusing lines and poor methods of triaging.

“More than 15,000 patients a year were still walking away without seeing any health care provider. You can’t feel good about that,” Earley pointed out. “If you really see the patients, look into their eyes, you can’t tolerate 15,000 a year walking away without any help.

“Today we have a daily census [in the trauma center] of 300 to 350, but we have a new way of triaging people when they come in the door. What we’ve gotten better at is ‘You will be seen’ and getting them seen, if not in the emergency room, then the appropriate clinic for the services they need. Sometimes that’s primary care, not trauma care. Our ER is still crowded, but our ‘left the scene’ rate is down to about 3 percent.”

JPS offers the only Level 1 Trauma Center and the only emergency psychiatric care in Tarrant County.

“We now have 1,500 to 1,600 psych patients a month come through our doors. We can’t say, ‘Sorry, we’re really very busy today. We don’t have room for any more patients, we are maxed out.’ No, we fit them in, as we should,” Earley said. “If they require a long-term stay, we send them to Wichita Falls, but we are the only emergency psychiatric facility in Tarrant County, and everyone who needs that kind of care comes through here.

“Society’s great equalizers are trauma and emergencies, and that includes psychiatric emergencies,” Earley said. “I’m not sure any of us are that far from a world awry.”

Looking to the Future

So what’s next for JPS?

An $809 million bond package was proposed earlier this year to fund a new 10-story patient tower, five-story psychiatric hospital and renovations to existing facilities. JPS officials have been working on the proposal for more than five years and a series of public hearings and interest group presentations is underway.

County commissioners have indicated they could call a bond election in 2016.

“We are often full, and we don’t have enough back-up. JPS needs to expand to meet the needs in this community,” said Earley. “We put clinics and provide care where we know we will have patients, not where we hope they will come. We don’t advertise. We don’t need billboards to get more people in here. This is a safety-net charity hospital system. Our mentality is different.”

Earley admits his decisions are not always popular but points out that he can’t use tax dollars to put services in the wrong place just because someone wants them there.

“I do a lot of explaining and try to be as honest about it as I can. You have to budget wisely. Sometimes I tell people things they don’t want to hear,” he said.

“There is no complacency here. We are not where we need to be, but we are making a lot of good decisions, we have a good board – a very good board – and we have a staff that wants to be here. They are proud to be here helping take care of people who need them. We take care of some really hard cases,” Earley said.

“I never planned to be the CEO at JPS. I came in as vice president for public affairs and advocacy. I was not gearing my career to be a CEO. This was an unexpected gift, but now that I have the gift, I think constantly about how to protect and enhance it. … It’s the best job I ever had.

“In all my time at JPS, I have never had a bad day. I’ve had some bad meetings and bad moments, but never a bad day.”

Carolyn Poirot is Fort Worth Business’ medical correspondent and previously covered health topics for the Fort Worth Star-Telegram.