HCA CFO, William Rutherford, says healthcare finance leaders should have a patient focus

September 27, 2023 2:54 pm

To be able to consistently perform at the highest levels, health system CFOs must have a strong commitment to clear and specific guiding principles. So says William Rutherford, CPA, CFO and executive vice president of Nashville, Tennessee-based HCA Healthcare, the largest healthcare system (by gross and net revenues) in the United States. And for Rutherford, the foremost guiding principle is to always be focused on the patient first.

“If we keep the patient at the center of everything we do, everything else will follow,” Rutherford said.

Appointed CFO of HCA almost 10 years ago, on Oct. 7, 2013, Rutherford has consistently adhered to a set of guiding leadership principles in his efforts to keep HCA highly successful both financially and clinically (see the sidebar below). By applying these principles with purpose, CFOs can achieve extraordinary results, he said.

A 37-year career path — following a mentor’s advice

Rutherford has spent most of his career at HCA, having been recruited directly out of college in 1986. He served in a variety of roles there from 1986 to 1996, when he was appointed CFO of what was then HCA’s Eastern Group.

In 2005, he left HCA to start a training and education company, leading to work with several private-equity firms. That also was the year he became a member of HFMA. He rejoined HCA in 2008 as CFO of its Outpatient Services Group.

Early in his career, when in his mid-20s, Rutherford had a boss/mentor who advised him to set short-, intermediate- and long-term professional goals — and to write them down because doing so lays a road map that is accessible over time.

To this day, Rutherford still keeps that small notebook-sized paper in his wallet. One goal from 1991 was “Become the HCA CFO” — which shows the value of writing down your goals.

Setting higher goals — and executing to achieve them

Rutherford acknowledges that as the largest healthcare system in America, HCA has a size advantage that gives it “the ability to add value through consistent operating practices that not all regional or smaller systems can adopt or execute.” Nonetheless, he ultimately attributes his organization’s advantage to the “power of discipline” and “discipline of execution.”

HCA has been able to be an industry leader in both margins and clinical outcomes not only because of its size, but also because of its practice of setting higher goals in clinical and financial metric outcomes, Rutherford said. And he emphasizes that smaller systems and individual providers can also set higher goals and routinely move toward achieving them. What’s needed is for committed senior leaders to instill this discipline of execution throughout their organizations.

Promoting cost effectiveness

Rutherford is committed to HCA’s fundamental purpose, which is to provide high-value healthcare, which he defines as “achieving the best quality outcomes, in the most efficient manner, while driving the best patient experience.”

To achieve this goal, Rutherford spends a large portion of his time allocating capital resources around three areas of input: building new capacity, developing programs (often through service-line initiatives) and implementing technology.

The intended output of these decisions is to drive a higher degree of clinical efficiency.

Regarding technology, for example, Rutherford said, “Many IT decisions are meant to bring more digital capabilities to the bedside, so nurses can be more productive and informed, physicians will have better tools and patients will have better experiences.”

Rutherford’s best HFMA memory

Rutherford is a member of HFMA’s Large Health System CFO Council, comprising finance leaders from America’s largest hospitals and health systems. The Council meets quarterly, and Rutherford has found it to be one of his “most valuable and rewarding” experiences.

“I have found that the issues facing all of us, whether investor-owned or not-for-profit, are remarkably consistent,” Rutherford said. “Although we need to be somewhat cautious of what we share, the experiences that we share and the participating and learning involved in these meetings is an incredible networking opportunity, which I am thankful to be part of.”

An opportunity to give back

“There is no more exciting time in healthcare than right now,” Rutherford said. “We have opportunities to make a difference in people’s lives and in how healthcare is delivered across the country. If we can find a small way to make a difference, that is a worthy cause to wake up to every day. That’s what keeps me going.” 

5 guiding principles for healthcare financial leadership from William Rutherford

Commit to a lifelong learning experience with a written professional development plan so that you can add value to your organization. The written document provides a concrete set of goals you can use to move forward. And as skill sets and organizations change, you can update your goals to include new technical and professional areas you are good at and add goals that may be outside your normal comfort zone, such as communications with diverse audiences.

Have a mentor/be a mentor. Understand the needs of the organization and the people with whom you work, and focus on developing them to their full potential. Be willing to spend time teaching them the ropes. And challenge them to dream big. Make them think about their goals: short-, intermediate- and long-term. Ensure they put them down in writing. It becomes a marker of their desires, be it professional or personal.

Maintain a positive outlook. This is a differentiating characteristic of leadership. Develop a high positive energy that can translate into determining why things can be done rather than why they cannot be done. It creates a more pleasant vibe in life and work.

Listen! While this is not always easy, welcoming other perspectives and input can make for better decision making. Specifically, it creates a culture of respect throughout an organization.

Be supportive of teams and teamwork. Teams that operate at a high level have shared objectives and value the different strengths of team members. This characteristic is especially critical in large, complex organizations, such as HCA, but is generally true anywhere.


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