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‘Ian McFadden: The Turnaround Developer

Dr. Ian McFadden, D.Sc., FACHE, Chief Executive Officer (CEO) of Sweetwater Hospital Association (SHA), has a pleasant and positive demeanor. Every word he speaks reveals his deep investment in the expansion and success of his organization, the growth of employees, and the well-being of patients. “Developer” is how he describes himself in a word because of his penchant for developing people, systems, culture, and organizations. The term ‘Turnaround CEO’ can also perfectly describe him. In his distinguished career, spanning almost 40 years in healthcare, Ian has turned around many failing organizations.

Ian took the helm of Sweetwater Hospital at a time when it was beginning to struggle financially. While still stable with money in the bank and no debt, it had not made any operation margin for five years. Within six months of joining the hospital, Ian steered it on a new path toward growth and success. The hospital reported a profitable fiscal year, ending June 2021, and it is expected to report the same this fiscal year as well. Ian believes that the hospital has unlimited potential, and the “ability to fulfill potential” is what keeps him going. He draws motivation from what else they can accomplish and do in the future. He rejoices when an individual working at Sweetwater Hospital can fulfill their personal potential. Ian wants to see people grow and develop, enter high positions, and go and run their own departments or even another hospital in the future.

Every leader wants to be successful in what they are doing, and Ian is no exception. As the CEO of Sweetwater Hospital Association, he wants to ensure that they are successful in what they are doing for their patients and community. “And anything we do to accomplish healthcare delivery, we want to do right,” he says.

An Accidental Start in Healthcare Administration

Ian became involved in healthcare administration by accident. He was a pre-med student in college, with plans to become a physician. “I, however, could not get through all the sciences,” says Ian. When he went home after his first pre-med year, his mother saw him frustrated, so she suggested he meet people at the local hospital. Ian’s father, a county commissioner and board member of the hospital, spoke to the administration and asked them to put his son to work for a few weeks while he was at home. His parents felt that it would instill in him discipline and focus. That summer, Ian worked for the CEO of the local hospital and got introduced to the administration side of healthcare.

“It taught me a lot and got me grounded in terms of this being what I really wanted to do,” Ian says. “Rather than trying to learn the concepts of practicing medicine, I discovered that I would like to work in healthcare delivery from a management perspective.”

Thereafter, the CEO took Ian under his wings every summer. During his school breaks, he would work in the hospital. Ian recalls that he was doing food service delivery, housekeeping, and intense labor types of work. The CEO would sit down with him every day and ask what he did. He then would point out to him how important his job was in terms of how the hospital works and how patient care is delivered. Because of his experience at the local hospital, Ian changed his major to health administration. “That is what I’ve wanted to do ever since,” he says.

Community relationships were important to him – they are important to him today as well – as his father was a “big-time community proponent.” He taught him the value of staying in touch with the community’s needs. “What I really wanted to do was to go into healthcare administration, run a hospital, and be part of a local community because the hospital is one of the key components of the community and its existence,” Ian says. “That has propelled me ever since.”

At every hospital where Ian worked, he tried to find out how the hospital could help the community, how it impacted people, and what could they do to improve that. Even when he got into turnaround work, Ian ensured that the hospital remained connected to the community and made sure its reputation enhanced the community’s reputation.

Turning Around Culture

Since graduating with a Masters in Health Administration from the University of Alabama, Birmingham, (UAB), Ian has worked at the top level of every hospital where he was assigned. HCA Healthcare was the first company following his residency where he served as the Chief Operating Officer, (COO), of a small hospital in Florida. Afterward, Ian worked for West Tennessee Healthcare in Jackson, Tennessee for nearly ten years helping to develop their system. Following a mission trip to Haiti, where he saw extreme poverty, he changed his philosophy and then joined an inner-city public hospital in Memphis as the COO.  “It was at the Regional Medical Center in Memphis where we developed a culture improvement process that became a staple for every turnaround I would do after that,” Ian says. “Turnaround is not necessarily only about financial and operational issues”, he explains. “It should be cultural as well. If you can turn around the culture, everything else is much easier,” adds Ian.

Ian has also worked for Cambio and FTI Consulting, major turnaround firms, as a consultant. After that, as an interim CEO, he turned around two struggling hospitals.  Then he served as CEO at Roseland Hospital in Chicago and Methodist Hospitals in Gary, Indiana. “That [Methodist] system went through a $73M turn around to become a market leader, and it is still today,” Ian says.

After completing his Doctorate degree at UAB, Ian then went overseas, where he formed his own firm called HRM International. His firm took hospitals in Saudi Arabia and Dubai and put them through the cultural development process to help them achieve rapid margin improvement with great success. “Covid changed all that,” Ian says. Beginning in 2020, he didn’t want to travel anymore because of the pandemic. So, he decided to return to the U.S. and find the right place to be in rural community health, which is the type of community he grew up in.

When he looks back, Ian considers himself fortunate that he got the opportunity to work in many environments where a hospital was either bankrupt or close to closure. He recognized that the hospital’s closure meant no access to healthcare for the community. This has motivated him to successfully turn around several different hospitals and make them profitable.

Early in his career, the hospital in Tuskegee, Alabama shut down in the late 1980’s.  Ian felt that he should have gone back and tried to help.

“I don’t know if I would have kept it from closing or not, but I would have liked to have the opportunity to at least try to help. I didn’t do that so I said, ‘Before I’m done, I’m going to a small rural community and do what I should have done those many years ago in my hometown,” Ian says. “Sweetwater is my new hometown and that is what we’re doing here. We’re building an integrated healthcare delivery system from a rural hospital.” Ian is glad that he has gotten the chance to do it and make right what he didn’t do before.

Ian joined Sweetwater Hospital in January of 2021.

New Core Values of a Dominant Player

Sweetwater Hospital is a 70-bed rural facility, serving East Tennessee. Ian, who has visited about 50 hospitals in the country and around the world as a consultant, feels that the model of Sweetwater Hospital is probably the best that he has seen of a rural world-class facility. The debt-free hospital has everything that a community expects to get from a healthcare perspective; including pristine facilities, state-of-the-art technology, highly qualified staff, plenty of doctors and specialists, and a good support system from the local community and areas surrounding the hospital. Ian adds, “We are also the only shareholder in a GPO as a rural hospital.”

The five counties, Meigs, McMinn, Roane, Loudon, and Monroe, that Sweetwater Hospital serves, view it as their “place of destination.” And it is a dominant player in this market and has good support from the physicians and other specialist in surrounding markets.

At Sweetwater Hospital, Ian says, all the facilities are newly developed. They recently added a new patient tower with an updated seven-bed ICU. There are plans to add eight additional ICU beds within the next year. The hospital has also added satellite facilities including Urgent Care, Industrial Medicine, and Physical Therapy. “We’re doing all these things because the extended market now recognizes Sweetwater Hospital as the place to go for healthcare,” Ian says.

Minimally Invasive Surgery (MIS) will be offered starting later this year with the Da Vinci Intuitive Robot already purchased and onsite. This will precede the start-up of a Diagnostic Cath Lab the following year for which a certificate of need has already been secured. Sweetwater Hospital has also made significant improvements in technology with the development of an all-digital platform for patient access in Radiology.  A new patient portal, online registration, telehealth, as well as PACs and digital mammography have all been added within the past year. Also, our CPSI Information System is continuously being upgraded to ensure the best patient experience possible.

The core values of Sweetwater Hospital are changing. Until recently, its image was that of a traditional rural hospital serving the population of Sweetwater, approximately 6,000 citizens. “Now, we want to go from taking care of people in Sweetwater and understanding their healthcare delivery needs to taking care of people of the entire five counties,” says Ian. “We can serve those 500,000 citizens without them having to travel to Knoxville or Chattanooga for everything.”

Ian points out that they are developing a systematic concept of taking care of a broad-based area of people in a region of five countries. As that entails becoming more innovative, they now foster innovation as a major value. “We also foster growth as a major value,” Ian adds. “We foster respect and integrity, and dignity for our people as major values. Building a culture of employee engagement is also important, and they have a family-oriented culture because everybody knows everybody in the town. All of this ensures our major focus of delivering a 5-star patient experience”.

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“We believe our responsibility is to take care of this region’s people, and we have that ingrained in everything that we are about,” Ian says. “We are changing our culture from Sweetwater-oriented culture to East Tennessee region-oriented culture. We want to put family values and patient experience at the forefront of that.” Sweetwater Hospital doctors are also committed to the East Tennessee region and its community.

“Our values are patient-focused and community-based,” says Ian.

Running the Hospital during Pandemic

“The pandemic was “devastating,” Ian says. He, however, quickly points out that they handled it better than most places. They experienced a lot of hurt and pain while trying to get people in and treat them. “You could not transfer anybody out anywhere because nobody was taking other patients,” Ian says. “We began treating patients not only for Covid but those patients with comorbidities as well.  We were treating patients for things we were initially not equipped to treat.” To quickly become equipped, we brought in specialists and added more manpower, however, there were still not enough nurses.

Sweetwater Hospital was full of patients every day. At the time, it was licensed for 60 beds, but some days, they over 85 patients. “It was a hard time for this organization.  “I want to commend our people because, during that entire 2-year time frame, we didn’t close any services.  “Our hospital did not send anybody away,” Ian says. “Our staff came in every day whether they were scheduled to or not, often signing up for additional shifts. Knowing the outcomes that people were experiencing in the community, our staff also felt they were depended upon and had come to work for their community.”

“People were thankful that the hospital became a resource and an answer for their needs during the Covid time frame,” adds Ian. Post COVID, the implementation of its display of community values, resourcefulness and being deeply rooted in the community Sweetwater Hospital was awarded the 2022 Monroe County Chamber Business of the Year.

Visible and Accessible CEO

When Ian joined Sweetwater Hospital, every department leader reported to the CEO – the reporting structure was very flat. Ian changed that. He formed an executive team, which currently consists of seven members, and adopted a decentralized organizational structure.

Employees now report to one of the executives, who then report to Ian.

Ian does not immerse himself in details on a day-to-day basis. The executive team does that. As the CEO, he focuses on where they are going in the future, the strategy, the development of the system, different partnerships and affiliations, and recruitment of positions. Because of Ian’s efforts, a new affiliation with the University of Tennessee is in Sweetwater Hospital Associations’ future vision.  The hospital plans to add a residency program for Family Medicine, and residents will be trained on the Sweetwater campus.

Delegation of responsibilities to the executive team does not mean Ian’s engagement with other employees is rare. He is very much visible and accessible, as well as open to ideas and inputs from others. “I always try to engage people,” Ian says. “I make sure that I get to know everybody who works here. We have over five hundred employees, and I’m proud to know most of them on a first-name basis – and I’ve only been here for a year and a half.” He thinks that it is important because all employees need to recognize the leadership – who they are and what they stand for. “So, I try to make sure I’m visible,” Ian adds.

He also tries to integrate everybody into the process; so, they have quarterly round-the-clock Town Hall meetings, where all the employees are encouraged to provide input into their needs and the vision for the future Ian describes.

“So, it’s not just one guy or a team of people at the top making all the decisions. Everybody has a shared vision and is involved in decision making,” Ian says. “That is what makes us very special. Everybody has ownership of this place. People look at this place as their home.”

For Ian, getting people engaged to the point where they feel like part-owners of the hospital is critical. “My role is to facilitate growth and further development.”

System Development, Name Change, and Other Plans

“System development” is where Sweetwater Hospital is headed under the leadership of Ian. According to him, a multi-year strategic planning process, including a facility master plan is near completion. He has also advocated for the appointment of more board members. Earlier there were 10 members, now it consists of 13 members. In addition to that, Ian also plans to further expand the executive team.

Ian and his team are also developing the Sweetwater Physicians Group, a division of Sweetwater Hospital Association. This group will consist of previously managed physicians and place them in an organizational structure under the umbrella of the hospital. The Sweetwater Physicians Group, Sweetwater Hospital, and the system’s entities outside of that, make up this new integrated delivery system serving the East Tennessee rural corridor. “So, between Knoxville and Chattanooga, Sweetwater Hospital will dominate,” Ian says. “We are a well-developed, integrated system now,” says Ian.

“Our focus is to take care of the market between the two metropolitan areas.  Hopefully, the patients in that area think that Sweetwater Hospital or the system of Sweetwater Hospital is where they can go,” he says, adding that “patients don’t have to worry about going to Knoxville or Chattanooga. Our patients can get everything done where Sweetwater Hospital serves in the five counties of East Tennessee.

“Sweetwater Hospital will continue to build upon its reputation.” Ian says. “We have already achieved a 4-star designated status for patient experience and our major goal is to achieve a 5-star designation by CMS. I definitely want to see that happen within the next year or two.”

Message to Healthcare Leaders

Ian’s advice to young leaders is, “Gain as much varied experience as possible. I have been in so many different organizations around the world, and I have seen how things run differently at very different locations.” These experiences have helped me become a better leader gaining knowledge from each organization.” “Young executives should strive to learn as much as possible in as many places as possible.” Ian’s advice to them is to go and get those experiences, which will help them in the long run.

In addition to getting as much experience as possible, young people should also be confident about it. “You must have enough confidence to take risks and make decisions,” Ian says. “Even if there is a mistake, make decisions anyway because you can overcome mistakes.”

Dr. Ian McFadden hopes to remain at Sweetwater Hospital for the remainder of his career.  Having served many hospitals throughout his career, Ian has received various awards. In 2002, Ian was awarded the “Top 100 Hospital” designation by Solucient at East Orange General Hospital.  In 2007, he then received a “HealthGrades” award for Pulmonary and Cardiology at Roseland Hospital. In 2012 at Methodist in Gary, Indiana, Ian was also recognized by Studer and Press Ganey both as being one of the most improved hospitals nationally in patient experience. Following that, in 2020, Ian was awarded the “Top 100 Healthcare Leader” from the IFAH (International Forum for the Advancements in Healthcare) for the turnaround work he performed in Saudi Arabia.

To read more about Sweetwater Hospital Association, visit

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