Elaine Couture has been with Providence Health & Services for 34 years, but she’s worked in health care for her entire career.

Couture, now age 65, first joined Providence as director of the organization’s TotalHealth program. She came to Spokane in 2002 to take on the role of vice president at Providence Sacred Heart Medical Center, and later became regional chief executive for Washington and Montana and executive vice president.

Couture’s successor, Joel Gilbertson, assumed Couture’s position on March 1, but Couture is remaining with the organization until May 1 in an advisory capacity.

The Journal spoke with Couture about her career, her time at Providence, and the changes she’s seen in health care and in female leadership over the years.

How did you get started in the health care industry?

Even when I was younger, I always was intrigued by what happened with the body. If somebody fell at the playground and they cracked their head open, I thought that was kind of cool — instead of running away from it, I ran toward it. 

I was babysitting in Chicago when we lived there, and the mother of one of the families I babysat for all the time was a nurse who worked evening shift in the emergency department. When she would come home at night, she would tell me some of the things she had encountered. I liked listening to her stories. I liked that she was wearing white, and I thought the cap was cool. 

Then we moved to Billings (Montana), and babysitting was not as lucrative in Billings as it was in Chicago, so I decided to volunteer. It continued my love for thinking about how to take care of people. It was a natural fit. I worked as a nurse’s aide when I was old enough to become certified. I went into school at Montana State University, and knew I was going into nursing. The only thing I’ve done is health care — I’ve never worked anywhere else.

Who has been your greatest professional role model?

In my professional career, one of my greatest mentors was Mike Wilson, who also served at Sacred Heart. I will always be grateful to him for all of the things that he taught me and the counsel that he gave. Mike always showed up. Mike always listened. He was very much a professional. 

He always looked at the glass as half full, never half empty. He was a visionary. He had a way of outlining what we needed to do and how we were going to get there. He deeply cared about the people and the organization. He was truly a mission-inspired leader.

What’s the most significant change you’ve noticed in the health care industry over the years?

One of the things that has changed over the years is the technology and the things we can do for people that don’t require them to stay in the hospital for weeks.

When I was working as a nurse’s aide, our very first open-heart surgery patient in Billings was in the hospital for about three months before the surgery, and then about three months after the surgery occurred. Today, physicians are operating on people and doing mitral valve procedures robotically. The length of stay has dropped. The technology has obviously enabled that.

In terms of the changes we’ve had, especially this year with COVID-19, we’ve quickly gone to telemedicine and transformed into seeing people on a computer screen. The express cares and the urgent cares have become part of the experience that people have in health care. 

I remember in the 1970s, the idea was that hospitals were going to become the one-stop shop for everybody who was looking for something in health care. When you think about health care, it’s not defined by taking care of people who are ill, or who have trauma, or need something more in-depth, in terms of diagnostics. Health care is really about how you think about wellness in your life and the factors that influence your health.

COVID has really exposed the inequities that we have in health care. We’ve talked a lot in the past few years about population health and how social determinants of health and zip codes and those kinds of things could determine how healthy you were. We have to think of health more globally and continue to focus in on those kinds of things. The healthier our community is, the healthier everybody is going to be. Hospitals are places where people who are sick or have trauma come to be seen. It’s an important part, but it’s only one part of it.

What changes have you seen in terms of women in leadership positions?

I was the first nonreligious woman to lead Sacred Heart. Women leaders were always in health care, but they were never the CEO. I didn’t have a lot of women CEO mentors when I was growing up. It wasn’t even something I saw. There was discussion even a long time ago about diversity. There was a lot of focus on how we diversify our workforce and make sure there’s a balance of males and females, and it’s not just all males at the top level of the organization.

I was selected by Mike Wilson to be the chief operations officer of Sacred Heart. That was a big thing. And people were making a big deal about that. He said, I chose you based on your skill and abilities, not based on the fact you’re a woman. That made me feel really good, because I wouldn’t have wanted it any other way. Over the course of the years, we’re seeing it even in board rooms. Companies that have women at the top do very well, and sometimes even outperform competitors. I’m glad that I was able to break through that glass ceiling for other women in the community.

What are the most pressing challenges your successor is taking on?

Health care is challenging at the present time, especially with COVID. As our margins continue to be squeezed, it makes it more difficult to make certain that everything balances.

When I was first in nursing, we went to a diagnosis-related, group-based reimbursement. Over the years, people are saying there’s a lot of money in health care, and we have to learn how to use those resources in the best way that we can. But it’s requiring us to make changes. The financial challenges will continue. I think the other challenge, more than the financial challenges, is that as our society is aging, there will be more demand for services, and yet, there will be a significant workforce shortage.

What do you see as your greatest accomplishment in your time at Providence?

Some of the things I’m most proud of are our collaborations that have brought new services into the community. I think about the respite care program that we started with Catholic Charities, and the ability to allow for people who are homeless to have a place to go that is safe and warm after they’ve been in the hospital. We have success stories that have allowed for people to move into more permanent housing, and we’ve been able to provide wraparound services for them.

The behavioral health hospital … was a collaboration to tear down the Fifth & Browne Medical Building and then go into a joint venture with Universal Health Services and Fairfax Behavioral Health to build up our psychiatric services so that we could serve more people who have mental health issues.

I’m proud of the millions of dollars that we’ve provided back into the community after we’ve already paid our taxes as a corporate citizen. 

The thing I think I’m most proud of is the people—the caregivers who work at Sacred Heart and Holy Family and Mount Carmel and St. Joseph’s and St. Luke’s—all of the Providence employees. Their work inspires me every single day. I’m very proud that I was able to lead and work with such a fine group of people.

What’s next for you?

I have six grandchildren. Five of them are younger and still want to have playdates with me. My intention is to spend more time on relationships with my grandkids, and also time with my friends.

We plan on doing some traveling, if and when the COVID pandemic is a little more under control. We own a home in Arizona. In fact, I’m taking off to go down to Arizona and spend a couple of months. If we can’t travel abroad, what we’ll end up doing is traveling within the U.S.

I’m hoping that I can continue to serve on boards that are affiliated with how we improve health care in the community. Those doors will open up for me if they’re supposed to.

This interview has been edited for length and clarity.