Dr. Andy Agwunobi says one of the things that convinced him to leave a high-ranking post in Florida and move across the country to the Inland Northwest was his desire to achieve a better work-life balance, one that would afford him more family time.

As CEO of Spokane-based Providence Health Care, the Inland Northwest's largest health-care system, for a little over a year now and also recently named CEO of both Providence Sacred Heart Medical Center & Children's Hospital and Providence Holy Family Hospital, some observers might wonder how he'll find that balance.

The nonprofit Catholic-sponsored Providence network, which encompasses 10 hospitals and organizations that altogether employ about 8,500 people, is being squeezed between unprecedented funding challenges and what it says is an urgent need to expand its facilities to meet an escalating demand for services.

"We are having to be very conservative with our expenditures," due to reduced state reimbursements, rising bad debt, and other factors, but it's important that capital improvements move forward, Agwunobi says.

In a seemingly contradictory coincidence of events, Providence expects soon to announce more staffing cuts and to hear whether state regulators have approved a certificate of need for a roughly $80 million portion of a planned $175 million expansion project at Sacred Heart. Both could occur yet this month.

Agwunobi said in an interview last week that the details of the staffing reduction still were being worked out, but that it would be larger than one announced in April in which Providence hospitals here eliminated the equivalent of 19 management positions. The hospitals had said then that additional layoffs might be necessary to weather the recession.

"We started off the year significantly impacted by the recession," he says. A number of cost-containment measures that Providence facilities have implemented have helped improve that financial picture, but the second half of the year still is going to be tough due partly to reimbursement cuts the Washington Legislature approved in its latest session, he says.

"We certainly are not in financial distress," Agwunobi says. Nevertheless, with revenues remaining soft and no end to the recession in sight, he adds, "For the rest of this year, we are going to be very focused on addressing the challenges of the current economy," and integrating Providence's various operations better to create a more seamless, efficient network, Agwunobi says.

That will include confining hiring to "mission-critical" positions, scrutinizing non-labor expenses with the same critical eye, and further reducing or streamlining services where appropriate, such as Providence did recently when it decided to close one of two adult day centers it has been operating here. Such centers provide meals, exercise, socialization, and health-care services to low-income elderly adults, but the centers here haven't been self-sustaining financially.

Of the one Providence is keeping open, near Holy Family, Agwunobi says, "We will absorb those losses."

Of the push to integrate Providence services more thoroughly, Agwunobi appears to be leading the system's two largest hospitals into somewhat uncharted waters. He says Sacred Heart and Holy Family now share management in various parts of their operations, such as with one vice president overseeing both hospitals' emergency departments. He adds he regards Sacred Heart and the formerly separately administered Holy Family now to be essentially "one hospital with two campuses."

Of the difficulty of weighing what cuts to make and what services to reduce, Agwunobi says, "We are particularly challenged by our mission, which is not to turn people away. For us, it's about compassion," and assisting the most vulnerable.

The health-care industry was one of the last industries to be hit hard by the recession, and probably will be one of the last to emerge, perhaps not until the second half of next year or later, Agwunobi says. Still, he says, "We're very optimistic" about longer-term prospects for the sector, and he adds that Providence is intent on forging ahead with development of the additional facilities it believes it needs to meet future demand.

The $175 million expansion project that Sacred Heart wants to build over about five years would add 173 licensed beds to the 623-bed hospital, plus give it a much larger emergency department, expanded intensive-care services, a new cancer center and doctors' building, and enough room to meet its growth needs until 2020.

The hospital said last fall that it was running at about 85 percent occupancy, with admissions growing at about 5 percent a year, and that patient volume in its emergency department was soaring.

Agwunobi says Sacred Heart had expected to hear a decision from the state Department of Health on its certificate of need application by early this month, but the agency said it needed another month to complete its analysis. He says that decision potentially could come before the month is out.

"Because of the recession, we will be very thoughtful about where we spend that money, but we know there are some things we have to build immediately," he says. "This is a shovel-ready project, and we will break ground soon after approval."

He says the overall scope of the project hasn't been reduced because of the hospital's weaker revenues recently, but notes that it's a multiphase project and says the timing of those phases might be altered as financial constraints dictate.

One area where Sacred Heart could see some revenue growth—despite the economy—is in major trauma care, following its decision some months ago to no longer share what's called a Level II trauma center designation with competitor Deaconess Medical Center. Under a joint operating agreement that had been in effect for years, the two hospitals alternated serving as the region's major trauma center on a week-by-week basis.

Sacred Heart's decision to begin offering major trauma care at all times, treating people critically injured in crashes, accidents, and crimes, contributed to a recent announcement by Deaconess that it plans to stop providing such care. It said, though, that it will continue to offer emergency room services for people with less serious injuries.

Agwunobi defends Sacred Heart's decision, saying the hospital needed to utilize more fully the facilities it maintains and the highly trained staff it employs around the clock. He compares it to operating a retail store that's only able to accept customers every other week. Deaconess initially took steps indicating it also might begin offering continuous trauma care, but then decided on its own to cease offering trauma care instead, he says.

"I think it was a smart decision on their part," since it's uncommon for two Level II trauma centers to be located so close to one another, he says. He also notes that major trauma cases are a comparatively small part of the overall spectrum of care, with Sacred Heart recording just 258 trauma "activations" last year in which staff was alerted about the pending arrival of a major trauma patient.

Though Agwunobi is juggling multiple CEO roles, he points out that each Providence facility under his purview has someone who is managing day-to-day operations, such as Elaine Couture, who is chief operating officer for Sacred Heart and president of Holy Family.

Providence Health Care is part of Seattle-based Providence Health & Services, a Sisters of Providence-sponsored nonprofit ministry that's among the largest health-care systems in the U.S., employing more than 45,000 people in five states.

Agwunobi lives in Liberty Lake with his wife, Elizabeth Nega, who is a doctor working in internal medicine here for Group Health Cooperative, and two young daughters.

He came to Providence Health Care from the Florida Agency for Health Care Administration, where he administered the $16.6 billion Florida Medicaid program and reported directly to the governor. Before that, he was the executive vice president and chief operating officer for St. Joseph Health System, a 14-hospital network in Orange, Calif., and president and CEO of Grady Health System, in Atlanta, Ga. He says all of those jobs kept him traveling and away from home a lot, which he hopes to remedy here.

Agwunobi is a third-generation physician, a practicing pediatrician until a year ago, and also holds a master's degree in business administration from Stanford University. Though his father, a surgeon, is Nigerian, he was born in Scotland and raised there until he was 12, and still speaks with a slight Scottish brogue.

Retracing his family roots and his father's educational path, he attended medical school at the University of Jos, in Nigeria, and did his pediatric residency at Howard University Hospital, in Washington, D.C., where he met his wife.

During his time in Nigeria, he says, he operated a small 12-bed hospital with an electric generator in a small village. "That was the first hospital I ever ran," he says, "and that was where I realized that if you're able to develop a system of care, you can impact the lives of a community."

Agwunobi came to the U.S. in 1992, and says, "I think it's very exciting that the Obama administration is seriously tackling health care reform in this country. I think we just have to see how in plays out in terms of the details," before judging it.

He says he'd like to see a system here in which health care is regarded as a basic human right. "Anything that gets us closer to that," he says, "is welcome to me. It's all about human dignity and the alleviation of human suffering."