Jon Ness, CEO of Coeur d'Alene-based Kootenai Health, has announced he will retire in early 2024, capping a 39-year career in health care. 

During his 13-year tenure, Ness helped transition Kootenai Health's flagship facility from a community hospital to a regional medical center and the trauma center for 10 counties in northern Idaho. It is also now the third largest health system in Idaho, with over 4,000 employees. 

Prior to this role, Ness, 67, was chief operating officer for 12 years at the Billings Clinic, in Montana.

The Kootenai Health Board has formed a committee and launched a national search for Ness' successor, who will be appointed after the health care organization has completed its transition into a 501(c)(3) nonprofit corporation from a public hospital district. 

The Journal recently sat down with Ness to discuss what inspired his career in health care, leadership lessons, and his retirement plans.

What was the incentive for transitioning Kootenai Health into a nonprofit corporation?  

The most common legal structure for hospitals or health systems is a private nonprofit corporation, such as Providence, MultiCare, and the Mayo Clinic—they're all nonprofit. About 25% of all hospitals in the country are publicly owned. They are owned by counties and (serve) hospital districts. The structure of hospital districts is based on taxing the community to generate operating funds.

Kootenai Health has taxing authority but hasn't used it since 1995. Our hospital district has elected board members, and by state statute, it is restricted to just nine members. 

Well, Kootenai Health has grown so much, we've almost tripled since 2010, and our board in comparison is very small. The election process has become difficult for partisan political reasons, so our board felt that it was time to make the transition. By Dec. 31, we will convert from a public hospital district to a private, nonprofit entity. 

All of our board members will be appointed, not elected. It will be a private corporation, similar to Providence and MultiCare. 

Why has the taxing authority not been used since 1995?

The political environment is North Idaho is such that our board's view--and I agree with it--is that health care already is expensive for people. The view is that we're here to serve the community. We're not here to tax them. As a result, every year in June, the board passes a resolution not to use the taxing authority. 

You mentioned the organization has nearly tripled in growth since 2010. Was that intentional?

Part of the growth was not just growth for the sake of growth. It was keeping pace with population increases. Due to the banking meltdown in 2008, there was a lack of growth not only here but across the country. The month that I arrived here, the unemployment rate was 12.5%. 

Then the U.S. economy started to recover, and we had to grow with the community. We built a long-term business plan to transition Kootenai Health from being a community hospital to a regional medical center serving all of North Idaho. We have the only family birth center neonatal intensive care unit in North Idaho, and a lot of the subspecialty skills that are necessary to serve the population are here at Kootenai Health. 

Growth came in more ways than just the hospital. When I arrived, I got ahold of some data that showed we had a significant shortage of physicians. So we created the Kootenai Clinic, which is owned and operated by Kootenai Health and has grown to have 285 providers. 

When you put forth this vision for growth, did you have any pushback?

Yes, of course I did. I spent several months analyzing and evaluating and had a third-party consulting firm here helping me. We built the business case that we needed to grow, and I got a few different responses. 

One school of thought from employees and physicians said, "Fantastic, that's what we've been waiting for." I had another group of people that were in the middle--"I'll wait and see" people. The third group of people said, "We have things here exactly the way we like it; there is no need to change anything."

When you're a CEO, it's important to understand the dynamics of how to move an organization forward. There's a leadership author, John Cotter, who said essentially, "If you don't create a sense of urgency, people are not going to want to change." 

When I started to get pushback, I used data from Washington state that showed that in 2009, the year before I arrived, there were $240 million in inpatient health care services provided in Spokane hospitals for North Idaho residents. People are leaving North Idaho to go to Spokane for health care because we lack services. That got everyone's attention. 

What led you to want to work in health care? 

When I was in college I spent a lot of time playing basketball and not a lot of time in the library. When I graduated, I applied and was accepted to the United States Peace Corps as a volunteer. I went from Fargo, North Dakota, to the Marshall Islands in the central Pacific Ocean for two years. I was the only non-Marshallese person on the whole island. I taught English, math, and health. 

There was a medical technician on the island who administered health care and delivered babies. When I arrived, he asked me to be his helper. I didn't have any background in health care, but I ended up helping deliver babies and take care of sick people. So of course, I came back and said I want to work in health care. 

Throughout your career, what are some of the best memories? 

The best memories are the people I worked with. There are a lot of fantastic people in the health care industry who are doing their very best to help other people. I can't think of anything better than that. 

I'm also a builder and grower. I like taking things and improving them, not just in terms of growth, but taking something already good and making it even better. Over the years and the places I've been, that's what I've done. I've always grown things. 

Did you plan to retire before the pandemic hit? 

The average tenure of a hospital CEO in the United States is five years. I've now started my 14th year, and just to put it in perspective, in the last 43 years, Kootenai Health has only had two CEOs. When I came here, I was committed to ending my career here. Well at about the time that I was 65, COVID hit, and there was no way I was leaving the organization in the middle of that. 

How was Kootenai Health during that time?

It's hard for us to forget it here because it was truly a crisis in the hospital. Kootenai Health was the COVID hospital for all of North Idaho. The Centers for Disease Control sent out the first alerts about COVID-19 in late 2019 and most of us in the industry knew that at some point we would have a pandemic. On March 13 (2020) we had our first patient, and we went into command mode and stayed in that mode for over two years. 

The difficult part of that was not just the patient care. We lost 1,000 employees during COVID-19. Stress, fatigue, and personal safety played a role. For example, imagine you're a nurse and you're in the third floor treating a COVID patient and outside on the street, there are people protesting COVID-19 vaccinations and Kootenai Health. Many of our protestors were saying it was a hoax. That is one example of a situation where it made it difficult for many employees to stay in the industry and in the position. 

Now that you're able to retire, what plans do you have? 

I'm not going to move. We like it here. But I've decided to do something I've never done in the past: I have a blank sheet of paper where anything is possible. I'm going to take time and really think about what I'm going to do next. I'm not going to make any commitments for four to five months and evaluate all the different things that I can do.

This interview has been edited for length and clarity.