As administrator of Orem Community Hospital, Laurel Kay has done more than just successfully climb Intermountain Health Care's corporate ladder: In a sense, she helped build it.

In 1985, Kay became the first female administrator of an acute-care hospital in Utah, and her first task was to oversee a construction project that remodeled and doubled the size of OCH."It was difficult becoming a construction manager and hospital administrator at the same time," Kay said. "During the time, my biggest challenge was they (IHC) were expecting me to be perfect right out of the chute."

That was four years ago, and it appears IHC's hopes in selecting Kay as head of OCH have been realized.

The hospital, which has operated in the red since it was first constructed in 1981, has been in the black for the past three months. The construction project was successfully completed and has given OCH a setup that is "user friendly," maximizing efficiency, privacy and comfort on the behalf of its patients. And, last year the facility reached record highs in the number of patients treated in all areas: births, surgery, emergency care, X-ray and overall admissions.

Much of the hospital's success can be traced to Kay and her willingness to do whatever it takes to get the job done. Kay, who was a cheerleader in high school, is still motivating people to succeed and do their best today, both by inspiration and by example.

During the reconstruction of OCH, Kay provided an opportunity for the hospital staff members to feel a sense of ownership in the facility by allowing them to be involved in designing the areas they worked in; the nursing staff in the maternity area picked out paint, wallpaper and furniture, for instance, and helped coordinate individual rooms.

She has tried to identify staff personnel with potential and help them by providing growth experiences as well as educational opportunities.

Kay as an example: She spent many hours following OCH's remodeling helping to put the finishing touches on the facility, including washing windows and helping to unpack new furniture.

"When you come to work in a small hospital you have to understand that you cross over jobs," Kay said. It is not every hospital administrator who can scrub down and assist on emergency Caesarean operations, as Kay did on three occasions during the Christmas holidays.

Kay's background as a registered nurse has not only provided her with an ability to provide technical assistance when needed but has given her a unique understanding of hospital operation. Before becoming administrator at OCH, Kay was director of nursing and assistant administrator at American Fork Hospital.

"I believe the bedside nurse is the backbone of any hospital," Kay said. "They are the most important person in the hospital. I strive to support those people to do a better job, to ensure they have the facilities, the equipment and the education to do a better job."

A patient, Kay said, evaluates a hospitalization experience based on his or her perception of what constitutes quality care. Hospitals need to pay attention to those moments where that experience is largely built: at the bedside, in care delivered by the registered nurse and other staff members.

Despite Kay's hands-on knowledge of hospital operation, backed by a master's degree in nursing emphasizing hospital management, the transition from director of nursing to head administrator was not problem free.

"As a nurse you work closely with staff but you don't lead and act as a model like you do in management," Kay said.

One of the most difficult hurdles Kay initially had to overcome was to redevelop her relationship with the medical staff in line with her new authoritarian position - working with physicians as partners rather than customers, for example. Developing her role in IHC management meetings also took time.

"I had to work at personally gaining acceptance as an intellectual, participative person in administrative meetings at the corporate and association levels," Kay said. "They tended to treat me as a spouse rather than an administrator. It took time to develop rapport. I'm a fairly aggressive person. It took time to develop a coat of armor and to not take things personally."

That transition was aided in large measure by Mark Howard, executive director of Utah Valley Regional Medical Center, whom Kay refers to as her mentor.

"I would not have been able to survive without a mentor," Kay said. "I had a number of good experiences (behind her), but Mark Howard was able to answer questions I had. Every time I had a problem I couldn't see my way out of, I could get Mark to tell me the consequences of the options. He is the type of individual who will help an individual develop skills by making suggestions rather than criticisms. He let me make mistakes, but he didn't criticize me."

Her family has also been instrumental in helping and supporting her climb up the corporate ladder, Kay said.

"The support of my family is tremendous," Kay said. She and her husband, Charles, manager of Herman's World of Sporting Goods in Orem, share family responsibilities; their children have had to become more independent and have "developed talents that they wouldn't have if I'd been there always doing things for them," Kay said.

But, Kay's success came about because of an additional factor: a desire to create change in the hospital setting.

"If there is any one thing, it is my desire to help create change," Kay said. "I felt management was a way for me to make change. We need to do much more as women, to take challenges. Women's contributions in all settings need to be emphasized."