On any given day, you might find Robert Earley, the president and CEO of JPS Health Network, roaming the halls of the hospital he’s governed for the past 13 years.
These weekly rounds originated with Earley, said Steve Montgomery, who chairs the financial committee for the network’s board of managers. They offer connection points between the president, the patients and hospital staff — whom he knows and addresses by name.
“If you’re watching close enough, you’re like, ‘Those are really personal interactions,’” Montgomery said. “That sort of esprit de corps he’s engendered is phenomenal to watch.”
In early November, Earley, 61, announced his retirement from the system effective in March 2022. The network’s board of managers, an 11-person cohort appointed by the Tarrant County Commissioners Court, will begin a nationwide search for his replacement — someone with the chutzpah to lead the system into “what’s next in health care,” Montgomery said.
“(Earley) got us to a really great place,” he said. Earley’s commitment to relationships big and small brought JPS Health Network out of a “bad spot” in the late 2000s. “But times are changed, and we need new things now.”
Earley was unavailable to comment for this story because of his schedule.
‘It was time to make a change’
Before Earley took the helm of JPS Health Network, the system’s relationships within the community — with the commissioners court, local health partners and the public — “had soured,” Montgomery said.
A monthslong Fort Worth Star-Telegram investigation into the system, which ran as a series in 2008, told of derelict conditions and patients who said they were “treated like cattle,” while the system’s cash surpluses grew. In those days, Tarrant County Judge Glen Whitley remembers receiving calls from hospital administrators throughout the county who criticized what they perceived as JPS Health Network’s focus on advertising, rather than patient care.
“I was getting a lot of complaints,” Whitley said. “And that was one of the reasons why, in talking with the board of managers, I felt like it was time to make a change.”
Within weeks of the Star-Telegram investigation, Earley took over from former CEO David Cecero as interim chief executive officer. In 2009, Earley formally took the helm.
Earley didn’t bring a traditional hospital administrator background. He was a former state representative and professor. He raises Clydesdale horses and bees.
“Robert is a great guy. He really is. And one of the things that he possesses, that I really think helps, is his keen sense of humor,” said Stephen Love, the president and CEO of the Dallas-Fort Worth Hospital Council. Love said he’s known Earley for 15 years. “He keeps things in perspective. And he always gives credit to the team around him.”
The board of managers at JPS Health Network, whose responsibility it is to hire and fire the hospital CEO, thought Earley’s public service background made him well-positioned to rebuild relationships within the hospital and community — and he has, Montgomery said. Montgomery was chairman of the board of managers when Earley was selected as CEO.
Within months of Earley’s tenure, physician satisfaction within the hospital had increased, according to news coverage of his first year as CEO. He spearheaded a more robust communications team within the hospital to increase transparency, Montgomery said. He’s often tapped to speak at public events or serve as a master of ceremonies. And, he’s become a fixture at the commissioners court meetings, Whitley said.
“In a public hospital, the CEO’s job is more external than it is internal,” Whitley said. That’s because JPS Health Network operates in part from taxpayer money and answers to the commissioners court.
Health care within a ‘political environment’
Texas law requires counties to provide health care to people who can’t afford it, and counties can fulfill that obligation in different ways.
In Tarrant County, the commissioners court created the Tarrant County Hospital District, or JPS Health Network, in 1959 to bolster the finances of an already-existing John Peter Smith Hospital. The hospital had, only a few years before, been renamed after the Fort Worth mayor who deeded the land on which it was built.
Since then, JPS Health Network has carved two distinct care niches in Tarrant County, Montgomery said. As the public hospital district, the system serves people in Tarrant County who don’t have insurance. And, as the only Level 1 trauma center in the county, JPS Health Network can provide the most comprehensive trauma care available from prevention to recovery. The network earned the Level 1 designation under Earley’s supervision.
The CEO of a hospital like JPS is responsible for overseeing the hospital’s finances, creating a hospital culture, building a leadership team, pitching ideas to the board of managers — tasks not dissimilar from CEOs of private or nonprofit hospitals, Love said. The CEO of a county hospital, however, operates within the spotlight of a “political environment,” he said.
“You just want to make sure that you explain what you’re doing, why you’re doing it, and why it’s going to benefit the community as a whole,” Love said.
About 40% of JPS Health Network’s budget comes from local property taxes. Another 40% comes from commercial insurance and payers like Medicare and Medicaid, and the final 20% comes primarily from other federal funds, Montgomery said.
Seeking the ‘next generation’ of health care leader
Earley announced his retirement in early November, citing his parents’ health as the impetus for his departure. He leaves the hospital in good relational standing with the commissioners court, local hospitals and the public, Montgomery said.
Earley’s retirement announcement also comes amid a slow-moving expansion project for JPS Health Network, supported by an $800 million bond package voters approved in November 2018. Plans for the project include the construction of four regional medical centers, as well as a behavioral and mental health hospital.
Whitley said he’s heard criticism that, since the bond’s passage, “we haven’t seen more dirt flying over there.” He attributes the delays in construction to a 2019 property tax law that ultimately didn’t apply to hospital districts, and the pandemic, not Earley’s leadership.
The new president and CEO will be able to steer and even reimagine the expansion project, Montgomery said. He’s not looking for “Robert part 2,” he said, but a “next-generation-of-health-care leader who really has their eye on what’s coming next.”
JPS Health Network’s newest strategic plan outlines what’s next: the development of a culture of shared accountability and learning among staff; a greater focus on patients’ social determinants of health — how the places where they live, work, learn and play affect their health; and a reimagination of how people access their health care in a world reshaped by the COVID-19 pandemic.
When it comes to patient care, these priorities might look like addressing “upstream” health needs like housing and transportation, Montgomery said, or offering treatment options like home care for an aging population. It might mean prioritizing telemedicine instead of creating more beds.
“What we’re looking to build has to be relevant 20 years from now, 30 years,” Montgomery said. “We don’t want to go build some huge facility (only to realize), ‘Hey, we don’t need that anymore. That’s not the way care is delivered anymore.’ That’d be the worst thing we can do.”
He expects the search for Earley’s replacement to begin shortly and extend nationwide.
“We won’t waste time, but we’ll take our time,” he said. “This is the single most important decision that a board like this can make.”
What’s the relationship between the board of managers and the commissioners court?
The commissioners court appoints people to be on the hospital’s board of managers. “We serve at their pleasure,” Steve Montgomery, a member of the board of managers, said. The board hires and fires the hospital CEO and approves hospital policy. Members of the commissioners court might be on the CEO search committee. Finally, the board creates the hospital budget but the court gives final approval of the budget.
Alexis Allison is the health reporter at the Fort Worth Report. Her position is supported by a grant from Texas Health Resources. Contact her by email or via Twitter. At the Fort Worth Report, news decisions are made independently of our board members and financial supporters. Read more about our editorial independence policy here.
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