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Marna P. Borgstrom

Yale-New Haven Hospital

New Haven

On Top of Her Game

Marna Borgstrom walks out of the shadow of her predecessor to place her own stamp on Yale-New Haven Hospital

Two thousand nine was an historic year for Yale-New Haven Hospital, an institution that traces its roots to 1826. In October, YNHH officially wrote the final chapter in the saga of its quest to shepherd the Smilow Cancer Hospital from idea to reality.

The gleaming new 14-story, 168-bed Park Street facility cost $467 million to build. But beyond the dollars, Smilow required considerable political capital on the part of YNHH’s president and CEO, Marna P. Borgstrom, who midwifed the project through years of community and union opposition, indifferent support (or outright hostility) by local politicians, regulatory hurdles and the obvious challenge of trying to complete a major capital improvement just as the economy of the city, state and nation plunged into deep recession.

For her tenacity and acuity in seeing through to completion one of the largest projects of any kind in Connecticut in years, Borgstrom is Business New Haven’s 2010 Businessperson of the Year.

YNHH board member John L. Lahey, president of Quinnipiac University, speaks for his fellow trustees in calling Borgstrom “a great CEO.”

One thing great CEOs do is get things done — in good times and bad. The genesis of the idea that would become Smilow goes back many years. While Yale-New Haven has long described its cancer care as “world class,” hospital executives calculated that it could be made even better if oncological services could be deployed under one roof.

For years “We knew that the East Pavilion building [erected in 1950], our big workhorse building, was going to run out of gas due to physical limitations,” Borgstrom explains. “We’ve rehabbed the 1982 building [South Pavilion] that’s connected to the East Pavilion. We built the Children’s Hospital [opened in 1993 in what is known as the West Pavilion] and connected it to the 1982 building.” The buildings were connected in part to share infrastructure such as food, supplies and materials.

“We knew we need to add beds, and we knew we needed to start taking some beds out of the East Pavilion,” Borgstrom says. The hospital already owned the Park Street land parcel that would become Smilow, so the issue became: “We can either plop a big building here, or we can look programmatically at where demand is and where it is growing,” Borgstrom says. “And when we looked at it, almost uniformly it was in the oncology disciplines — medicine, surgery, neurosurgery, pediatrics. Oncology, unfortunately, is a growing business.

“Like many medical centers, we were taking our sickest patients and walking them all over — ‘You go for your radiation here, and your blood work is over there,’” she explains. The decision to move ahead with Smilow was the answer to the question: “How can we do a better job of keeping all these services very localized for the patient?” Borgstrom says.



With 944 beds, Yale-New Haven was already the largest hospital in Connecticut. With almost 6,500 employees, it is New Haven’s second-largest employer (after the university whose name it shares). In addition, the parent Yale New Haven Health System operates Bridgeport and Greenwich Hospitals. Not only is the Yale New Haven system a linchpin of the state’s health-care infrastructure, but it wields formidable political clout as well: The boards of the health system and the hospital are larded with many of the region’s heaviest hitters.

At the center of them stands a petite, perfectly coiffed 56-year-old, her figure trim from her four-times-a-week running regimen. Borgstrom assumed the positions of president and CEO of Yale-New Haven Hospital and the Yale New Haven Health System in October 2005. Before that she served as executive vice president and chief operating officer since 1993, with responsibility for strategy and operations. From 1985 to 1992 she was vice president of administration.

Borgstrom came to the hospital 31 years ago as an administrative resident fresh out of grad school and navigated her way deftly through staff and operating positions of increasing responsibility and authority. It’s the only place she has ever worked.

After graduating from Stanford with a degree in human biology, Borgstrom came east to attend the Yale School of Public Health, from which she earned an MPH in 1979. She immediately went to work at the hospital as an administrative resident on a one-year fellowship.

She describes her acclimatization to the hospital as “a humbling experience. I didn’t really have a job description; I didn’t really have a job. I had this rarified opportunity to sit in meetings with senior people in the organization.

“I had this little teeny tiny office across the hall from the hospital barber,” Borgstrom recalls of a time when YNHH had — yes — a barber. Naturally, the barber shop “was the gossip center of the medical center, because all the department chairs and all the professors used to get their hair cut [there], and he would know who was being hired, fired, promoted — whatever.” She calls the experience “the old version of social networking.” But what it afforded the young administrator was a window on how senior executives talked and acted and thought. Those lessons were not lost on her.

Nevertheless, she insists her career was never propelled by a master plan for world domination. Instead, Borgstrom keenly identified and seized opportunities as they presented themselves.

Immediately after her 12-month fellowship expired she became a full-time administrative staffer — “They need someone to keep a seat warm,” she jokes now. At the time YNHH was building its South Pavilion and Borgstrom oversaw planning for moving patients into the new facility.

When that project was completed in 1982, then-CEO C. Thomas Smith “wanted to embrace strategic planning,” Borgstrom recalls. “Hospitals didn’t really do strategic planning back then, and what I knew about strategic planning I had learned in a couple of classes a few years before at Yale. [Smith] formed a board committee and I did what most people who have been given a responsibility they don’t know how to do — I hired somebody who had expertise in it.”

It was an astute hire (Borgstrom remembers the staffer, Dana Faulker, as “one of the smartest people I had ever worked with”) and provided the still dewy-eyed 30-year-old administrator a key lesson in management — the power of leverage.

Working on what became the hospital first-ever strategic plan became “a defining moment of my career,” Borgstrom says. At the pivotal meeting of the board committee to present the draft plan, “I did the opening and the close, and [Faulker] did this whole [presentation] of what’s the vision, strengths, weaknesses, opportunities, threat-analysis — she was just brilliant.

“I remember afterwards, cleaning up, I was feeling both good and bad,” Borgstrom continues. “I didn’t feel I had really contributed that much to the conversation. Tom Smith walked out of the conference room with me and put his hand on my shoulder and said, ‘Marna, this was a great meeting.’ I said, ‘I know it was, Tom, but I didn’t do it — Dana did it.’ And Tom said, ‘I know she did — but you were smart enough to hire her.’

“That was my first great ‘Aha,’” Borgstrom says, “that you go out and surround yourself with the very best and smartest people that you can find — and then letting them do what they do.” Not long after Borgstrom was named vice president of administration and on the fast track to the highest reaches of the hospital’s administration.



Smith left YNHH in 1991 to take a job with health-care consulting firm VHA Inc. in Texas. He was succeeded by Joseph A. Zaccagnino, whom Borgstrom has publicly credited as her mentor and most influential figure in forming her professionally.

“The day [in 1993] that Joe sat me down and offered me the job of executive vice president and chief operating officer, I was stunned,” Borgstrom recalls. The EVP post was newly created and a tacit sign that she would in the not-too-distant future be anointed as Zaccagnino’s heir apparent.

But remain on that trajectory would require a solid record of accomplishments and astute choices about taking on  assignments she was confident she could turn into wins.

“What I learned from Tom and then Joe was that you get more responsibility if you [prove you can] do all the things you were given to do,” Borgstrom says. “If you’re one of these people who is always busy and always harried, no one’s going to give you more to do because they’ll be worried that they’ll sink you.

“Then as you grow, and you get more [responsibilities], your role is not be as much of a doer as it is to be a conductor — and let the people who are doing do it and do it well,” Borgstrom adds.

If Borgstrom has derived a management philosophy from her experience, it is this: “Don’t try to over-manage, or tell people how to do something you don’t know how to do.”

Borgstrom remains close to Zaccagnino, who lives in Madison (the Borgstroms live next door in Guilford) and at 64 remains active on area boards of directors. “Even though he’s only seven years older than I am, Joe still feels a little bit like a proud father that things have gone so well” since he retired, says Borgstrom of her mentor.



Borgstrom and the health system she guides have a keen stake in the shifting national health-care landscape. And although no one in New Haven or Washington, D.C. knows today exactly how the “reform” will play out, Borgstrom views the future with equanimity.

“Now that health-care reform has been slowed by political changes, there’s a part of me that’s actually a little bit disappointed,” she says. “Although there are a lot of things I was worried about with health-care reform, I don’t think you could find anybody in a leadership role in our industry who doesn’t recognize that things have to change — there are an awful lot of things that don’t work perfectly.”

She says that in discussions with board members of both the hospital and the health system about coming changes to health-care delivery, there are two principles that “will guide what we do: One is that patients and there families have a right to expect that care is better coordinated and better communicated and better organized than it is now,” Borgstrom says.

“The second thing we have to do is to recognize that we’re going to be a cost-driven business,” she says. “As we look at insurance reform and giving people more [insurance] coverage for health-care services, unless we’re willing to spend more on health care, in the short term we’re going to give people coverage and access, and it’s going to cost more money — or you’re going to pay providers less. So we’re going to have to up our game on the one hand, and have to be very, very focused on reducing our costs.”

What are some practical means to achieve that goal?

“Less duplication of work and efforts among providers,” she says. Also, “We would have a way of rationalizing high-end, expensive care so that it didn’t become a mandate for every physician or every community hospital to have a full spectrum of services regardless of size or demand just in order to [maintain] their market viability.”

In terms of the big picture, “A lot of the [forces] driving costs and utilization are functions of social issues — largely poverty,” Borgstrom observes. “People who don’t have healthy lifestyles [are more likely than others to experience] the onset of diseases that can end up being expensive, chronic conditions.”

In addition, “People who are poor and/or who don’t have [insurance] coverage will not access health care at the same point you or I might,” she says. “They will not get an annual mammogram or a PSA. They’ll wait” until they get really sick to see a doctor — “and then you’re into a whole other level of care,” Borgstrom points out.

In terms of the really big picture, Borgstrom doesn’t need to remind herself that running a major health-care delivery system is not the same as running a widget factory. Every hour of every day there are decisions made at her place of business that confront life and death.

Rather than compartmentalize as a coping mechanism, Borgstrom and her senior management team walk regular rounds to visit with patients. “Unless you’re having a baby, most [patients] don’t want to be here,” says the CEO. “It’s very humbling and it’s very painful to see sometimes. And our staff — the people on the front lines of direct patient care — I don’t know if I could do what they do.”


In a 2006 interview shortly after ascending to the corner office, Borgstrom recalled realizing as early as 2000 or 2001 that, barring some grievous misstep or act of God, that she was Zaccagnino’s most likely successor. At that, she recalled, she had thought it would be “fun to run a place be able to implement some of my ideas.”

So, after five years in the hot seat, is it still fun?

“Yes,” Borgstrom replies, “and it’s been more fun as time has progressed because once you start to be a little less anxious all the time and you’re able to sit back and reflect, it becomes easier to move things forward.”

Nevertheless, she acknowledges that her first two years on the job were “very stressful.” At the time Yale-New Haven was embroiled in an ugly and very public war with the Service Employees International Union (SEIU) over the latter’s drive to unionize hospital workers. The set-to attracted national attention and generated accusations on both sides of intimidation and misconduct.

Out of deference to its core political constituency, City Hall appeared to side with the union in the dispute and held up needed city permitting for the cancer-center project to advance. At the same time YNHH was under fire for its policies in pursuing unpaid patient bills, policies Borgstrom and other hospital officials defended as consistent with nationwide industry standards.

In four-plus years in the top job, Borgstrom has taken her share of bumps and bruises. Nevertheless, she says without hesitation, “I love this job.”

That Borgstrom has been able to navigate those troubled waters and push Smilow through to completion she counts as the signature triumph of her still-young tenure as president and CEO.

With the crucible of the cancer hospital project behind her, Borgstrom surveys the horizon and sees a future landscape filled with what Winston Churchill characterized (in his 1940 “Finest Hour” oration) as “broad, sunlit uplands.”

“We don’t have a crisis or burning platform [now], and we’re in a position for Yale-New Haven and the [parent Yale New Haven] Health System of  saying, ‘What’s game-changing? How do we really start to up and change the way we play the game?’”

“And that,” Madame President concludes, “is fun.”