Q. What are some of the big issues facing healthcare in Hawai'i today?

A. I think the most pressing healthcare issue is access to local care that is being threatened by severe financial pressures. For example, Kahuku Hospital. If you examine very closely every healthcare facility in the state of Hawai'i, it is a reflection of what is happening nationally. The demand has simply outstripped our ability as a country to properly finance operations that deliver the quality of care that Americans expect from the healthcare system.

Q. What other hurdles are there for healthcare?

A. There is a critical shortage of healthcare personnel. We see it in certain areas of physicians' specialties. I know it exists now in primary care physicians and surgeons in certain parts of our island. Here at the Rehabilitation Hospital of the Pacific, it is physical therapists, experienced nurses who are trained in rehabilitation, and the list goes on and on.

Q. What niche does the Rehabilitation Hospital fill in Hawai'i's healthcare system?

A. In general, people look at all hospitals, including ours, in terms of technology. Especially expensive technology, such as MRI scanners, very sophisticated operating suites and intensive care units. At Rehab Hospital, unlike acute care hospitals, the service we provide is really high touch, low tech. In order to do that, we have to have the kind of professionals who are experienced and trained in medical rehabilitation. But the tough part of this besides the training part is that we need professionals who understand that very small gains are important to the patients we serve, whereas in an acute care hospital, patients are there to seek actual cures to their diseases or inquiries. At Rehab Hospital we accept the long-term nature of the physical impairment they have as a result of disease or injury, and work with the individual in improving very specific functions that add or restore value to their lives, such as walking, sitting, toileting, swallowing, speaking and thinking.

Q. How large an operation is Rehab Hospital?

Q. We have approximately 1,600 admissions per year. We also have about 6,000 patients seen in our outpatient clinics, any one of seven that we have across the state. The hospital has 100 beds; 80 beds are devoted to the very complex, severely disabled patients. Patients who have been struck by stroke or spinal cord injury or brain injury. Then we have what we call a subacute unit, which has 20 beds. That unit admits patients that require a lower level of intense rehabilitation.

Q. You worked at the Rehabilitation Hospital of the Pacific in the 1980s and 1990s before leaving to become president and chief executive of Queen's Health Systems. What prompted you to return to Rehab Hospital last year as chief medical executive?

A. When I retired from my executive position at The Queen's Health System, I went into a semiretirement mode, seeing patients twice a week and actually re-learning how to play and relax. Then I was approached by the Rehab Hospital to help the organization out, given my background, knowledge and understanding of the hospital. They wanted me to stabilize its place in the medical community, help develop relationships with physicians, help the organization understand what is the demand we need to be addressing since nobody else is looking at those patients. It seemed like a challenge and was something that I could contribute to.

Q. What lessons did you learn about leadership in your roles at Queen's and Rehab Hospital?

A. I think there is a discipline to leadership, and to the extent that we are all different, we have leadership skills and experience that we apply from one place to another place. What makes the difference in whether you are effective is what each environment calls for in terms of leadership. It calls for a kind of leadership that is adaptable, flexible; a leadership that listens, a leadership that understands the importance of supporting those individuals who deliver the direct care to patients. My basic principle is that in any leadership position I've served in, I'm always there to support the fundamental relationship that exists between the physician and the patient. If I'm unable to do that ... I'm not an effective leader.

Q. What made you want to pursue a career in medicine?

A. I was heavily influenced by my mother growing up, who was a graduate of the old Queen's Hospital School of Nursing. She was of that generation of nurses that had a clear, mission-driven commitment to the care of patients. I was influenced by her and many of the physicians she introduced to me in my younger years. I made a decision that medicine was an area that I wanted to go into. Having said that, I was, for a period of ambivalence, majoring in political science. After my first two acceptances to medical school, I turned them down because I thought at one point in my University of Hawai'i life that I would go into a political science graduate program. Then I had good counseling from people at the UH and I decided to accept the invitation to go to Washington University.

Q. What prompted you to move from practicing medicine to the administrative side of healthcare?

A. At a relatively young period of my life in medicine, I realized that I would enjoy the practice of medicine more if, in addition to seeing patients, I would have the ability to effect change at a broader level. That led me to my first breakthrough job of being a medical director of an inpatient unit in Seattle. Through that experience, I began to appreciate that you have a multiplying effect on individuals if you can develop programs. I went down that administrative, management path realizing that the complexity of delivering good, sustainable, affordable care was not just a matter of clinical delivery, but it was also making wise decisions about other aspects of healthcare delivery.

Q. What are some of the differences in the way nonprofit and for-profit hospitals are run?

A. It's clear for those organizations that are for-profit that they have owners to whom whoever is running the organization must report to in terms of profitability. Those that may be publicly owned have shareholders who have an investment in the productivity or profitability of the organization. That doesn't mean they aren't mission driven, because good business has a good mission — they're not mutually exclusive. In the not-for-profit world, I think our burden to society is to provide those services that nobody else wants to provide, such as those at the Rehabilitation Hospital of the Pacific. Having said that, though, without a margin, we have no mission. So we have to deal with the realities of healthcare financing to make those operations possible, to fulfill those unmet needs in the community based on our mission.

Reach Alan Yonan Jr. at ayonan@honoluluadvertiser.com.