By default, more so than by design, managing hospitals in a state of flux has become her de facto forte. Needless to say, she feels right at home in her latest role as CEO of MedWest-Haywood — a hospital with a limping economic ledger and identity quandary.

“I think they appreciated my background because I have been in some unsettling and challenging hospital environments,” said Sinacore-Jaberg.

Of course, that’s not exactly a novel résumé claim among hospital CEOs these days. What smaller hospital isn’t facing a litany of challenges?

“I would daresay any CEO we were entertaining would have had experience at a hospital in a similar situation,” said Frank Powers, a retired financial services manager with Smith Barney who is on the MedWest-Haywood Board. “In the environment we are operating in, most if not all hospitals are operating in a state of flux.”

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Where Sinacore-Jaberg stands out, however, is how she handles the near-constant adversity faced by her hospitals.

“I was able to calm waters and pull the team together,” said Sinacore-Jaberg.

Sinacore-Jaberg has been described as approachable, non-intimidating, extroverted, friendly and charismatic. She’s universally called by her first name “Janie” — partly because her hyphenated last name is a bit iffy to pronounce, but mostly because she’s just “Janie.”

As Sinacore-Jaberg strolled through the hospital lobby en route between meetings one day last week, she stopped to chat with a new mom who was leaving the hospital with a newborn baby in her lap. Sinacore-Jaberg knelt down, smiled and cooed at the baby, and asked the mom whether she’d been taken good care of during her stay — as if the tired and tattered mom was a VIP guest at the Omni and Sinacore-Jaberg was the bellhop.

She took another brief detour, this time behind the main information desk, to introduce herself to one of the many senior volunteers who help man the hospital switchboard. Within seconds, Sinacore-Jaberg was clutching her hand, listening intently as she recounted her husband’s recent surgery.

Her charismatic bedside manner might be a holdover from her early days in the healthcare field as a nurse. But don’t let the painted nails, high heels and flouncy scarves fool you.

Back in the board room, Sinacore-Jaberg is all business. She thrives on it, in fact. After her first couple of stints as a hospital CEO, she stepped back down to the role as chief operating officer — and soon decided that wasn’t for her.

“Quite frankly, I was a little bored. I missed being a CEO,” she said.

Despite her role as the top administrator, Sinacore-Jaberg still sees health care as a calling. She settled on a career in health care at 16 after her father died of a massive heart attack while she gave him CPR.

“I knew then. I told myself I want to do something in health care,” Sinacore-Jaberg said.

She initially went to school to be a surgical technician then worked her way through nursing school. After becoming an operating room nurse, she quickly moved to a head nurse and then chief nursing officer, before making the leap to chief operating officer and ultimately a hospital CEO.

Sinacore-Jaberg is in a relatively small fraternity of hospital CEOs in the country. There’s only about 4,000 of them. They tend to move around, staying no more than a few years in one place on average.

That’s certainly been Sinacore-Jaberg’s trajectory, hospital hopping five times in various CEO or COO roles from Ohio to Georgia to South Carolina.

There’s a few universal rules of thumb though.

“Priority one is patient care. I don’t care what hospital you are at,” Sinacore-Jaberg said.

Priority two? Meet the needs of your community, doctors and employees.

“That’s the same for any hospital,” she said. “If you don’t do that, you don’t have any business running a hospital — if I can be blunt, which I typically am.” 

General principles aside, each community has its own dynamic, and learning what that is in Haywood has been Sinacore-Jaberg’s mission of late. 

“She is eager to learn our community. She takes the time to go out and meet other people,” said Norm Yearick, a hospital board member and retired manager of Corning manufacturing plants.

Keeping it local

With a $113 million operating budget and 943 employees under her, Haywood isn’t the biggest hospital Sinacore-Jaberg has run. But she was drawn to it nonetheless.

“Look out the window is one,” she said of why she came.

But the allure of living in a beautiful place wasn’t what sealed the deal.

“Ultimately in the end, what tripped my trigger over this is the medical staff and their absolute dedication to the success of this organization,” she said, citing the high caliber of Haywood County’s doctors. “You don’t always find that, and in fact, you rarely find that in my professional opinion.”

The medical talent and expertise, plus the sheer depth of medical specialties, is “extraordinary” for a community of Haywood’s size, she said.

“And I don’t use that term lightly,” she added.

She’s primarily worked in the for-profit hospital world. And even now, while at the head of a nonprofit community hospital, Sinacore-Jaberg’s ultimate boss is the hospital giant Carolinas HealthCare, a Charlotte-based network of 32 hospitals of which MedWest-Haywood is part.

Carolinas was already familiar with Sinacore-Jaberg before she interviewed for the job. One of her most recent CEO posts was at the hospital in Mount Pleasant, S.C. There, she was locked in a fierce battle with a competing hospital, owned in part by none other than her current boss, Carolinas HealthCare. 

Carolinas, simply put, was impressed by her maneuvering in the competitive health climate, and it is still a bit of a running joke.

“When I go to corporate, it’s like, ‘Ha, gotcha on that one, didn’t I?’” Sinacore-Jaberg said.

Despite being answerable to Carolinas, she can’t wear her corporate allegiances on her sleeve. Haywood patients still cling deeply to the idea of a community hospital, and that pride could ultimately help drive them to get their health care at home instead of Asheville.

“I make sure that I am part of this community. I am going to go to Kiwanis and Rotary and churches and meetings with county commissioners,” she said. “That’s what you do. You use as much community involvement as you can.”

While patients claim they like the idea of a community hospital in principle, the “bigger must be better” syndrome has been a thorn in Haywood’s side.

“That is a philosophy in a lot of things, not just health care,” Sinacore-Jaberg said. 

Too many patients are driving the half hour to Mission Hospital for medical care they could just as easily get at MedWest-Haywood, and stemming that tide is a top priority — if not a critical one.

“What we have to show is we are here for our community. We have the quality, and we are going to show you we have the quality,” she said.

‘Person of the hour’

Sinacore-Jaberg has her work cut out for her, however. MedWest-Haywood had a roughly 10 percent negative operating margin for the last fiscal year, ending Sept. 30, 2012. It was one of the worst records it has posted in recent years.

Meanwhile, the number of hospitals in America has shrunk from 10,000 to 4,400. Another quarter of them could go out of business before the hospital industry hits the bottom, wagered John Young, a vice president for Carolinas HealthCare, the parent company of MedWest with a 32-hospital network.

Sinacore-Jaberg has to make sure Haywood doesn’t become one of them.

But Sinacore-Jaberg is hopeful. During the past 18 months, the hospital has bit off a lot. It opened a new urgent care center in Canton, opened a new outpatient surgery center, implemented a costly new electronic medical records system, purchased several physician practices and has seen success recruiting new doctors.

All that cost money, of course, but has created momentum.

“I think we are very well set to take it to the next level,” she said. “The baseline is there. I feel like we are moving in the right direction.”

The board of MedWest-Haywood said Sinacore-Jaberg is proving to be the right person for the job.

“We will have to face the changes in health care in a bold way. Janie is the right person of the hour to do that,” said Yearick. “The fact that she came up through the ranks, she knows a hospital is more than a business but a place where we show our county residents compassion and the need for quality care — and at the same time recognizing financially it is a struggle.”

Board members lauded the wealth of experience Sinacore-Jaberg has in the health care industry. But they also see her as simply a positive presence.

“She is a high-energy person and very in tune with listening to people and relates well,” said Mark Clasby, a hospital board member and the county economic development director.

One of Sinacore-Jaberg’s strengths is rallying those around her for a common goal and purpose.

“I am not a manager — I am a leader. I have a firm belief in that. I hope to lead change and hope to have people who are smarter than me to make that happen,” she said. “I don’t micromanage. My team will tell you that. If I need to micromanage them, I don’t need them.”

Sinacore-Jaberg has been the helm of MedWest-Haywood for roughly 100 days. For nearly a year before that, MedWest-Haywood was without a permanent CEO following the departure of Mike Poore.

Poore got out just as the hospital’s finances were tanking — and just as its fledgling partnership with Harris and Swain hospitals under the new MedWest banner began to unravel.

A vice president with Carolinas Health-Care, the management company over MedWest, stepped in as acting CEO. But the result was a protracted holding pattern.

“That desk is a big hole,” Sinacore-Jaberg said. “When the head leadership role is gone, you are a ship without a rudder.”

Uncertainties ahead

One of the biggest issues facing Sinacore-Jaberg — although one she declined to speak about much — is the strained relationship inside the MedWest partnership. The partnership was forged three years ago, bringing the hospitals in Haywood, Jackson and Swain under one umbrella.

Hospital leaders and doctors had high hopes for the newly formed alliance at the time, but the medical communities in Jackson and Swain — which had previously formed a two-hospital alliance — were dissatisfied almost from the start.

The sentiment ultimately led them to officially declare last summer that they wanted out of MedWest and to go their separate way from Haywood. Whether leaders can work through their differences and hold the partnership together will be decided during the coming year by the MedWest board.

Sinacore-Jaberg is no stranger to hospital mergers or the struggles and clashes they can bring. Twice, Sinacore-Jaberg has overseen hospital mergers. 

There’s no magic formula for making it work, and every joint venture is different, she said. One thing she’s learned is that new partnerships take time.

“It takes a long time, years, to develop a strong relationship between your organizations,” Sinacore-Jaberg said.

But whether the two sides are willing to give it the time — or just want out — remains to be seen. Sinacore-Jaberg plans to let the board of directors for each hospital chart the course and didn’t offer her own opinion.

“Do I know what we should do right now? No. I need to see what the boards want to do,” she said. “I think I need to see what shakes out.”

In Sinacore-Jaberg’s eyes, MedWest-Haywood’s largest challenge is something that it has no control over.

“Ask me what keeps me up at night? Reduction in Medicare and Medicaid reimbursement,” she said.

With the lion’s share of Haywood patients on either Medicare or Medicaid, the shrinking federal reimbursements mean the hospital doesn’t recoup the actual cost of treating patients. Yet it simply has to take its lumps, struggling to offset the losses with an ever-increasing goal of greater efficiency — a factor that forced a workforce reduction of 80 employees last year.

“You just get smarter. You work harder,” she said.

These days, you won’t hear Sinacore-Jaberg complaining she’s bored.

“I am called to organizations that are challenged. I want to help,” she said. “I’m the kind of person who continues to push even when people put blocks in the way.”