Starting out in healthcare as a financial analyst is a somewhat unusual place to embark on the career path to becoming CFO of large academic medical center (AMC). But that’s the path that Wendy Fielding, MBA, a 30-year member of HFMA, took on her journey to becoming CFO and system vice president of finance at Dartmouth-Hitchcock, a major AMC in Lebanon, New Hampshire.
Fielding also said she values the lessons she learned from her early experience as a financial analyst. And she continues to draw on the skills she developed at that time, approaching every issue with curiosity.
The perspective she carries with her from those early days is reflected in the motto Fielding lists on her LinkedIn page: “I catalyze action by bringing financial information to life, teaching the stories behind the numbers.”
Throughout her career, Fielding also has had other important and diverse opportunities to learn how to be nimble in her management and leadership. After starting out as a hospital senior financial analyst, she was director of budget and reimbursement for hospitals in the Boston area.
She then moved to her first CFO position at a critical access hospital (CAH) in Bar Harbor, Maine.
Coming from an urban hospital in a major Eastern U.S. city to a small hospital in a rural setting right on the Atlantic Ocean was an eye-opening experience, Fielding said.
“It was harder to recruit and retain staff, and there was less equipment and money to manage,” she said. “I think it is an important formative experience for any budding finance leader to learn how to do more with less.”
As CFO of a CAH, she saw her role and responsibilities expand significantly from her previous general accounting and finance role. She also oversaw departments that were new to her, including IT, facilities and revenue cycle.
Regarding that change, Fielding said, “It was scary and daunting, but it gave me a broader perspective and helped me to understand how all of these areas were connected to each other. I became a jack-of-all-trades, attempting to help resolve barriers that hindered effective outcomes. My financial analyst background helped me listen closely and understand what was really happening so that I could give every issue the proper risk management. It also allowed me to tell a more understandable story to the governing board or when being grilled by the finance committee chair.”
She credits this strong foundation as the basis of her success in her current role of CFO at Dartmouth-Hitchcock.
Breaking down barriers
Like so many of healthcare’s most prominent senior finance leaders, Fielding is a strong proponent of her organization’s commitment to the objectives of value-based care through the delivery of high-quality care and support to achieve optimal outcomes at the lowest possible cost. And she also is a strong believer in improving access to healthcare, which is an important part of promoting cost effectiveness of health (CEoH).
Maintaining access to care was a key challenge for hospitals posed by the COVID-19 pandemic, while the increasing need for clinical and hospital care found them struggling with reduced staffing, supply chain upheaval and higher cost for these services and goods. AMCs such as Dartmouth, in particular, had significant pressure on their capacity, due to the teaching nature of their services. With its surgical backlog growing, Dartmouth could not keep up with the demand for procedures.
“But we determined that the heath system had capacity at our critical access hospitals,” Fielding said. “Our leadership shaped and directed patient flow for better resource utilization. The CAHs are a lower-cost setting and using their open surgical slots and physician availability allowed our health system to develop a higher overall patient capacity, thereby improving access.”
With this change, Dartmouth was able to improve financial performance through lower-cost operations while simultaneously improving access, Fielding said.
“In the final analysis, we were able to break down barriers between the health system, the critical access hospitals and the community,” she said. “It was a win-win.”
Fielding’s best HFMA memory
Fielding recalls fondly an opportunity to visit London about 14 years ago as part of HFMA’s US/UK Exchange Program.
“During the exchange, I was able to job shadow with a hospital finance colleague,” she said. “I went to a London hospital performance meeting with their finance leadership and management. Although we like to think that U.S. and U.K. hospitals operate and are reimbursed very differently, I was struck by the similarities in questions that the U.K. finance leaders had to answer. It was fascinating to participate in this meeting, and it is my favorite HFMA memory.”
Words of advice on effective healthcare finance leadership from Wendy Fielding
Wendy Fielding offered five tips on her years of experience on how to be an effective healthcare finance leader:
1 Don’t worry alone. Share your worry. You will learn new information that removes the worry and enlist colleagues who will help you start tackling the issues.
2 Listen. If you are going to be an excellent financial leader, have a good set of ears. I learn something new almost every day by listening to my clinical and operational colleagues. Hearing other perspectives is incredibly valuable for moving forward with issues, projects and strategy. It leads to better solutions.
3 Know the facts, but tell the story. Learn how to communicate about financial issues and performance in ways nonfinancial folks can understand.
4 Appreciate the differences. There is such a large variety of providers in our industry — rural and urban, large and small, academic and non-academic — with different structures and reimbursement status. Listening and understanding the ways in which different finance and operations leaders confront their issues provides valuable insights into better decision-making at our own facilities.
5 Just teach. Share your knowledge with others. It allows your leadership to extend beyond your tenure. Experiment and practice the knowledge you want to leave behind. If something doesn’t work, try to explain it in a different way, perhaps even visually. What we are doing is complicated. Simplify, simplify, simplify.
Editor’s note: With this series of columns, we recognize the dedication and insights of HFMA’s longest-standing members, healthcare finance executives with memberships of 25 years and longer. If you would like to share your perspectives, please feel free to contact the author.