In the mid-1800s, two groups of faithful women, dedicated to caring for the poor and sick, journeyed to a booming riverfront town in Ohio. The Franciscan Sisters of the Poor missionaries from Germany created the beginnings of a hospital in Over-the-Rhine, while the Sisters of Mercy group that sailed from Ireland established a hospital in Hamilton.

In 1999, the two organizations joined to form Mercy Health Partners of Southwest Ohio, the second-largest hospital and healthcare system in Greater Cincinnati.

Today, a tall, easy-going man can be seen strolling the halls of Mercy's hospitals and healthcare facilities. In the crazy, complicated business of modern American health care, Thomas S. Urban has to navigate the mazes, shoulder a load of responsibilities, answer to boards and regulators, yet constantly keep in mind he's entrusted with people's lives.

Urban was named president and CEO of the Mercy system in 2002 after Julia Hanser retired. He also serves as Senior Vice President for Catholic Healthcare Partners, Mercy's parent organization that is based in Walnut Hills and is the largest health system in Ohio. Prior to that, the Xavier University graduate worked in hospital administration around the country, then returned here to take over as president of Mercy Hospital Fairfield, where he led the bold move to build a center for open heart surgery.

Except for the gray that streaks his hair and mustache, Urban could pass for 10 years younger than his 53 years. His relaxed demeanor and calm confidence offer no hint of the pressure he handles.

As a history buff, Urban appreciates what those Mercy and Franciscan sisters were up against in the 19th century. He will tell you he draws inspiration from their faith, sacrifices and determination. Being entrusted with their cause is a source of strength to him, especially because he sees himself as a "servant leader."

"Our metrics hold us accountable for fulfilling the mission of the sisters," Urban notes. The core principles of the Mercy mission are compassion, excellence, human dignity, justice, sacredness of life, and service. He says those special responsibilities actually make his job easier. "It's purposeful work. We're really doing God's work," he explains. With humility he adds, "And I have to surround myself with good, strong business people."

One of those is Mercy Hospital Fairfield CEO Jeff Ashin. He's a seasoned outsider, having worked at hospitals around the country. "Tom Urban is one of the people who falls in the category of really great leader," Ashin concludes. "He leads by example and models the behavior he expects from us."

Having risen through the ranks, Urban relates well to the challenges his employees face daily. "He's committed to our mission and to the community," Ashin says. "He's respected by people he works with and by healthcare professionals throughout Greater Cincinnati."
Service"”and health care in particular"”were ingrained in Tom Urban. His father was a doctor and his mother a nurse. His sister is a physical therapist and he has a brother working in hospital administration in Philadelphia.

So much has changed during his 30-year career in healthcare administration. In the beginning there were no "systems," just independent hospitals"”"and people went to the hospital for everything." Medicare paid the actual expense of diagnosing or treating a patient, with a little extra margin. Urban hospitals weren't driven by competition. People were patients to be ordered around, not "customers" to be satisfied.

Today, the healthcare crisis in America is well-documented. An aging population is living longer while expecting premium care. The ranks of the uninsured grow.  Medicare, Medicaid and private insurers shrink their reimbursements while raising accountability standards. The need for nurses and other allied health professionals rises as the number of young Americans entering those fields declines.

"We knew we needed to change" in response, Urban says. The local Mercy Health system was created in 1993. The first in the Tristate, it's a true family, not a loose alliance. It marked a trend toward regional networks of healthcare delivery and what is now known as the "continuum of care."

Five hospitals form the core of the not-for-profit business: Mercy Hospital Anderson, Mercy Hospital Clermont, Mercy Hospital Fairfield and the two former Franciscan hospitals, Mercy Hospital Mt. Airy and Mercy Hospital Western Hills. The system extends to five "senior living communities," medical and imaging centers, home care services and three "healthplexes" for wellness and fitness. Urban was an eager proponent for those centers, which are proven successes.

Other changes include a corporate emphasis on community involvement, education and outreach. Mercy has to nurture partnerships with physician groups, which have become more independent and powerful. And sometimes Mercy forges special alliances with its competitors.
Under Urban, Mercy Health Partners is sustaining an operating margin of about 3-4% on revenues of $600 million. The organization employs 7,000 people in the Tristate.

Mercy has chalked up some notable successes recently. The two Franciscan hospitals, which had been losing money, are more stable now. Last year, Medicare ranked U.S. hospitals on specific quality standards, such as emergency protocols and practices for patients with heart attacks. Twelve area hospitals ranked in the top 10 percent nationally"”and five of those were the Mercy hospitals. Surprisingly, the highest local Medicare scores went to Mercy Clermont.

In March 2006, Mercy's Anderson and Fairfield hospitals were two of four Greater Cincinnati hospitals recognized as a "Top 100" facility in the nation by Solucient, a company that helps healthcare managers improve their organization's performance.

Urban says these accolades also signal a trend that many Cincinnatians don't fully realize: migration of the best technology to the outer suburbs. Not so long ago, advanced medicine and the top specialists were clustered near the city's famed "Pill Hill." Now the newer "outer ring" hospitals offer menus of specialty care and the latest medical technology, and many top doctors have moved their practices to the 'burbs.

Mercy Fairfield acquired the hottest thing going in cardiac imaging, a 64-slice CT scanner, which gives cardiovascular surgeons visualization of abnormalities and clogged arteries with an accuracy meeting or exceeding the invasive technique of angiography.

Just weeks ago, surgeons at the Anderson hospital performed the first open heart surgery in the new cardiac care center there"”a cause for celebration in the Mercy family. But this invited more criticism from analysts who say Tristate hospitals have gone too far in a medical arms race. In particular, they charge that Greater Cincinnati has too many cardiac hospitals per capita, compared to comparable metro areas including Cleveland and Columbus.

Urban understands the complaints. He counters that Mercy Health Partners and other hospital groups are meeting demand in the areas where population is booming. The number of people showing up in suburban emergency rooms with heart problems kept rising. "We're tuned in with the communities, and people just don't want to travel far for advanced medical care," he explains. "We've had instant success with these programs because of pent-up demand."

Patients want great care close to home. Corporate America wants something done about healthcare insurance costs. Urban empathizes. "As an employer, we also struggle with double-digit inflation," he notes, adding that medical professionals "are notorious for over-utilizing" health care.

He concedes that the current system of health care in America is "broken" and "unsustainable." He sees some value in the Health Savings Accounts being pushed by the Bush administration, because the approach could make consumers more cost-conscious about medical decisions. But he admits this is just one part of a possible solution. "It requires dialogue and hard work among all parties."

Through its healthplexes and various awareness and education programs, Mercy has been a leader in the shift to focusing on health and wellness programs that can keep people out of its hospitals, and using alternatives to hospitalization for chronic conditions ranging from diabetes to congestive heart failure. "On any given day, 70 to 80 percent of our beds here are occupied by patients with chronic conditions," Urban notes.

Yet insurers reward hospitals that operate at full occupancy. "That's the conundrum. We're paid on volume. It's a perverse incentive system," he says with a sigh.

What does the future hold for Mercy Health Partners? There's a medical center sitting on 18 acres in the Harrison area to the west, which has the "potential for growth like Clermont," Urban observes. But he's not looking to compete on every front. "It's better to invest in what we have through same-store growth."

It all rides on more unforeseen changes in demographics, physicians, customers"”that is, patients"”and whether the American healthcare system stumbles along, or undergoes historic transformation. And for Tom Urban there will be one other factor: the guiding force of the Mercy mission.

THE TOM URBAN FILE

NAME: Thomas S. Urban
TITLE: President and CEO, Mercy Health Partners (Southwest Ohio Region), and Senior Vice President, Catholic Healthcare Partners
AGE: 53
HOMETOWN: Buffalo, N.Y.
EDUCATION: B.A. sociology, Colgate University; master's degree in health administration, Xavier University. He is a Fellow of the American College of Healthcare Executives.
HOME: West Chester
COMMUNITY ACTIVITIES: Butler County United Way (past chair), Greater Cincinnati Health Council, St. John's Parish in West Chester.
FAMILY: Nancy, a respiratory therapist ("an exceptional wife and mother"), a daughter and one son in college, and one son in high school.
FUN AND RELAXATION: "It's all about the family." Kept connected with his kids by coaching youth soccer and lacrosse. Loves boating, tubing, waterskiing and fishing with the family. Enjoys reading history, such as Flags of our Fathers.