Three decades with HCA gives new CEO unique insight on successes and challenges

When he joined HCA back in 1982, Milton Johnson didn’t have his eyes on a corner office. He was just formalizing a relationship that had already been in the works for a couple of years.

“I was with what is now Ernst & Young, and had spent a couple of years working with HCA’s accountants, so I’d been walking the halls over here since 1980,” says Johnson, HCA’s former CFO and president, who became CEO following Richard Bracken’s retirement at the end of 2013. “I’d been with them since right out of college, working in the tax department.”

At that point in HCA’s history, the company had a large international presence, and Johnson worked with the executives in charge of managing hospitals in Saudi Arabia, Australia, the Philippines and Singapore. Over time he developed relationships with many of those men and women, even helping them with their personal tax returns. So when HCA offered him a position in its tax department, it was a homecoming of sorts.

Right away, Johnson dug in and got down to the business of helping HCA succeed. In those days the company was busy growing by acquiring rural hospitals, and then integrating them into the HCA structure. Dr. Tommy Frist, one of the company’s founders, who is known for spotting talent, encouraged him to think more broadly about his career. So, Johnson began traveling the country with the development team, meeting the people who planted the seeds for what is his ongoing vision of HCA’s success.

“I really got to see and get a sense of the importance those rural hospitals held in their community,” he says. “I learned very quickly that healthcare is a local
business. People have an emotional attachment to their church, to the high school and to that hospital. When you talked about buying that facility, it was an emotional discussion. It really taught me the value of what we do.”

“I’ve been very fortunate in that every five or six years I’ve been given a new opportunity,” he says. “I’ve tried to make sure that I get the most out of the opportunity the company gives me.”

Relationship building is key

He credits company founder Dr. Tommy Frist and former executives Jack Bovender, Clayton McWhorter and Richard Bracken with helping him develop his executive vision.

IMG_4933“I learned the value of relationships from them, and that healthcare is a relationship business,” he says. “You’ve got to put the patient first. Keep in mind that I came from the financial side, so it’s easy to get caught up in Wall Street expectations and investor expectations, but at the end of the day why we exist as a company is for the care and improvement of human life.”

Johnson is well aware of HCA’s magnified role as a healthcare leader in the United States. He can quickly rattle off many examples of the work being done within HCA and in collaboration with outside organizations that continue to cement the company’s reputation in that regard. This includes nationally recognized efforts to reduce hospital-acquired infections, reducing MRSA in ICU populations and working to eliminate elective deliveries before 39 weeks.

“I could go on and on,” Johnson says. “These are just some of the things that are being learned at HCA that have now become clinical standards around the country. But how is that intellectual capital going to line up with the change toward consumer-driven health care? Patients are making more and more choices about where they seek care, and how they get it. Our size and scale is going to give us many advantages.”

Patient experience is paramount

That said, it is vital that everyone at HCA keep the patient’s needs first and foremost. That has become increasingly visible in a landscape that now features online ranking services and review sites, but it has always been the company’s main mission.

“Top of the list of things we need to do for the future is improve the patient experience and improve quality,” he says. “A quality outcome is of paramount importance, but a higher awareness of what the patient is going through while we are achieving those great outcomes is important as well. It comes down to compassionate care. Are we communicating well? Are we managing a patient’s pain well? Are we keeping our facilities clean? Are we making sure we have the best equipment? All these things are contributing to the patient experience, and playing an important role in where the patients choose to go for their healthcare.”

And even in the midst of major healthcare upheaval, HCA succeeds because of its people.

“We have fabulous caregivers and physicians, and they are always trying to do what’s best for the patient. As long as we do that, we’ll be able to navigate through these times of change,” Johnson says, adding that HCA’s consistent quality care also has a stabilizing effect.

“Keeping the mission of the care and improvement of human life at the forefront has given us good financial results, which in turn allows us to ride out changes,” he says.

Honoring the HCA culture

In the end, he says, success comes down to every single employee — and that’s where HCA will win out.

“When I visit our hospitals and sit down with our employees, I see the indefatigable pride that they have in what we do,” Johnson says. “They know the need to improve our patient satisfaction and experience, and no single person has all the answers. But, collectively I know we’ve got the solution, and that’s the power of our organization — the 200,000-plus employees who are giving care to our patients every day and have seen it all. Our job is to harness this organization’s power to create meaningful change in healthcare. We can do that, and do it now.”

As for Johnson himself, he plans to be actively involved at every level of the organization. In June, however, he might be forgiven for seeming a little distracted.

“Our daughter is due with our first grandchild then,” he says. “I expect we’ll be spending a lot of time with that grandchild once he or she gets here. Other than that, I’m just focused on the job and its requirements. I am really blessed in that I enjoy what I do every day. It doesn’t feel like a job at all.”

Johnson’s HCA Career Timeline
1982: Joins HCA
1987: Heads HealthTrust tax department when HCA spins off company
1995: Returns as vice president of tax when HealthTrust folds back into HCA
1998: Becomes senior vice president and controller
2004: Named executive vice president and CFO
2009: Named to the board of directors
2011: Named president
2012: Named CEO (beginning 2014)

HCA Chief Executives*

Dr. Frist Sr1968 Dr. Thomas F. Frist, Sr.




JohnHill1970 John A. Hill




JohnNeff1973 John C. Neff




JackMassey1976 Jack C. Massey




Donald_MacNaughton1979 Donald S. MacNaughton




Frist, Jr.1983 Dr. Thomas F. Frist, Jr.




RickScott1994  Richard L. Scott




ThomasFrist_Option21997 Dr. Thomas F. Frist, Jr.




Jack Bovender 0334 022001 Jack O. Bovender, Jr.




RichardBracken2009 Richard M. Bracken




MiltonJohnson2014 R. Milton Johnson





*Held the title of President, CEO or President and CEO