Now heading into her 45th year as a registered nurse and 20th year with Adventist Health Castle, Kathy Raethel reflects on her career-defining turn as Castle’s first woman president, including leading the organization to win the 2017 Malcolm Baldrige National Quality Award, the nation’s highest honor for performance excellence and quality management.

Congratulations on landing the Malcolm Baldrige National Quality Award. What an accomplishment!

It was a long journey—close to 20 years in the making. Our clinical results are the best in the nation in some categories, and our engagement results are also among the best in the nation. Our associates and physicians are happy, and, most importantly, our patients are very satisfied with the care they receive.

We call it “chasing zero”—making sure that no harm comes to patients while they’re in the hospital. There are a lot of infections people can get when they’re in the hospital, which slows down their recovery, and we’ve been able to avert those before they happen.

Falls are also a problem in hospitals—patients are on medications, they’re unsteady on their feet—and we’ve been able to prevent a tremendous number of them. We discovered that people were falling on the way to the bathroom, and so as we say at Castle now, nobody potties alone.

It’s all about training our associates to make sure they have the skills they need and know what the best practices are. Sometimes best practices emerge somewhere else, and if you’re paying attention, then you can be an early adopter of those best practices.

Where were you when you found out about winning the award?

I was on the mainland at a system meeting when I got the call from the secretary of commerce. I was really emotional, but I held it together until after I hung up. I had promised Steve Bovey, our quality improvement coordinator who championed the Baldrige process here for the whole 20 years, that he’d be the first to know if we won. I couldn’t speak—I was just blubbering—so I called my husband and then I called Steve. Our system CEO was speaking at the conference center next to my hotel, so I went down and told him next, just as he was getting ready to go on stage.

But even more exciting for me was what happened when I came back. I got to my office really early the next morning, and there was a housekeeper cleaning the corridor outside. She put down her mop and came over to me and said, “Mrs. President”—she’s the only person who calls me that!—“I have chicken skin. We won the Baldrige award!” Even the housekeeper recognized that we as an organization had won it and that she’d done her part. It was a really lovely moment.

That’s what it’s all about—disseminating that effort throughout the organization. They don’t just want to know that we in the administration can tell the story. They want to know that every person in the organization understands the mission and the part they play in achieving those results. I mentioned preventing infections—housekeepers are a really important part of that. Now we’re doing the work of sustaining those results and making sure we’re still worthy of the award.

Were other Hawai‘i facilities in the running?

I don’t believe anyone in healthcare here has made the choice to pursue Baldrige excellence. It’s a lot of work. We’re part of a nationwide system, and there are other Adventist hospitals that are on that journey, but not everybody gets to the finish line. We are the first and only organization in Hawai‘i’s history and in our 22-hospital healthcare system to receive the award.

That’s not Castle’s only noteworthy accolade in recent years.

We also made Healthgrades’ list of America’s 250 Best Hospitals for 2019. That was a big honor. There are about 6,000 hospitals in the country, so to be top 250 was pretty cool. Again, we were the only one in Hawai‘i and the only one in Adventist Health’s nationwide system.

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In addition to our America’s Best 250 Hospitals Award, we received Healthgrades’ Outstanding Patient Experience Award, Critical Care Excellence Award and America’s 100 Best Hospitals for General Surgery Award.

We’re also recognized by the Women’s Choice Award as one of the country’s top 100 hospitals for patient experience and have earned consecutive “A” grades for patient safety in Leapfrog’s Hospital Safety Grade program.

The SafeCare Group ranked us 23rd among the nation’s 4,500 acute care hospitals, placing us in the top 1 percent in the country for patient safety.

Castle recently purchased Hawai‘i Pacific University’s 132-acre Hawai‘i Loa campus in Kane‘ohe. What’s the vision for that expansion?

Our vision is for a beautiful, healthy campus that’s focused not just on illness, but on health. It will be home to Windward O‘ahu’s first cancer center—including a 5,000-square-foot radiation treatment space—and we’ll be adding outpatient facilities and a new 160-bed hospital with single-occupancy rooms over the course of the 15-year redevelopment.

We’ve invested hundreds of thousands of dollars on solar panels, charging stations and other energy efficiency measures with the goal of it being an environmentally conscious operation to serve our patients and the community into the future.

What else is new at Castle?

We brought on a spine and neurosurgery program and expanded and renovated our emergency department. We used to have curtained bays that weren’t very private, so now we have individual rooms with a glass doorway that goes cloudy when you flip a switch.

Certain things can’t be treated here—if you fall off a ladder from a certain number of feet, for example—so we’re also working towards Level III trauma designation. The tunnel closing shined a light on that need, and we’re working really diligently to get that certification so people in Windward O‘ahu don’t have to be taken all the way to town.

Tell us about the name change from Castle Medical Center to Adventist Health Castle.

We’ve actually been an Adventist facility since our inception in 1963 and have had several name changes along the way. The change to Adventist Health Castle was about shifting the focus away from being hospital-centric. We really believe that we’re here to care for the community. We don’t want to wait for you to get sick. We want to help you stay well.

Are there specific issues in our community that Castle is working to address?

We do a community health needs assessment every year in concert with the Healthcare Association of Hawaii, and we look specifically at our Windward population as well. Diabetes is a huge problem, so there’s a lot of effort there.

Homelessness is another one. It’s a tough issue that we can’t solve ourselves, but we try to be part of the solution. We have a behavioral health unit with 29 beds, where we often serve members of the homeless population. It’s a busy place, unfortunately. We’ve just hired psychiatrists who are there all day, every day, and we work with the Institute for Human Services, which has shelters downtown as well as transitional care homes in our neighborhood where we can discharge patients for integration back into the community. We’ve really taken a holistic approach in these respects.

We also opened a rural health clinic in La‘ie, which is an area of great need, and just recently opened the neighborhood’s only dental clinic.

You’re the first woman in the history of the organization to hold the position of president. What advice to do you have for women looking to get ahead?

Do a really good job at whatever task you have in front of you. I’ve rarely interviewed for a position. It’s always been somebody tapping me on the shoulder because they recognized a job well done.

It’s not about aspiring to a position, it’s about doing really great work. And if someone asks you to do something that’s outside the realm of what you’re comfortable with, go for it with gusto. Make a name for yourself.

What leadership best practices have you picked up along the way?

A great leader is someone who wants to help others, not just be autocratic and tell people what to do. We’ve cultivated a sense of servant leadership in our associates. At Castle, it’s our belief that we’re all in this together. I think that’s why people enjoy working here. It’s really a kind and compassionate place, and you notice it when you walk around. People are friendly, they make eye contact, they enjoy each other’s company.

Castle is big on career development and promoting from within. What kind of resources do you have available?

In addition to an Emerging Leaders program and an on-site MBA focusing on healthcare management, we offer educational opportunities through our new COPE Health Scholars program. I heard about it several years ago and went to the mainland to visit a couple of places where they were bringing in high school and college students for on-site experience and training. I was blown away by the aspiring physicians, physical therapists and nurses I met in these programs.

Students can spend the entire summer or as little as four hours a week with us getting hands-on experience and deciding what area of health care they might want to specialize in. The hope is that, now that they have an introduction to Castle, maybe they’ll want to come back and work for us someday. We’ve already hired a couple of them part-time.

What’s the best advice you’ve ever received?

When I first took this position, the system CEO told me, “Surround yourself with people who you have to tell “whoa,” not “giddy up.”

That story about the housekeeper is a great one. What’s another memorable moment from your career at Castle?

When the former president here, who I worked with years ago, asked me to consider joining Castle, I initially turned down the offer. But after several months’ convincing, I agreed to come and visit the hospital, and they flew my family and I out here from the mainland for a long weekend. Our daughter was 11 years old at the time, and when we came out onto the breezeway, she stopped and said, “Feel that, it’s like the wind is kissing my cheek!” My decision could’ve been made at that point.

But the moment I walked into Castle, I knew it was a special place. I’d spent my entire life in hospitals, and this was different. People were friendly—you felt welcome in a way that I had never experienced before. And that still exists today, perhaps even more so. It’s a place where you feel comfortable, and that’s really important for a hospital.

I had a local family, a brother and sister, make an appointment to come see me last year. At first I thought maybe they were upset about something. They told me their mother had passed away unexpectedly in the emergency department, but that when the doors to the ED opened, they felt like they had stepped into heaven.

I hear it from people all the time. One wrote to me from the mainland, “Lucky me, I had a life-threatening condition and got to be seen in one of the best hospitals in the country.” They fall in love with Castle, but what they fall in love with is the people who care for them. We care for patients like they’re our own family.