"If they don't say 'Go Blue' back, I know they're just wearing something they bought and are not Michigan fans," said the 66-year-old chief executive who's best known not for her Michigan ties, but for creating 27 consecutive surpluses in the hospital's operating budget.

That's led to a bigger and more modern physical plant and, what's most important to Shyavitz, finding top notch clinicians to fulfill the hospital's pledge, "Amazing Care, Surprisingly Close."

The surpluses came even after supplying millions of dollars of uncompensated care year after year for people who can't or won't pay.

It's a remarkable feat, especially in the tough economic times of the past five years and the health care industry in general, where controlling costs and enhancing revenues is a constant struggle for CEOs.

While members of the community read about the surpluses on the hospital's website or in the newspaper, it's what's produced by the money that's the true bottom line, Shyavitz said.

The foundation

A solid financial footing creates the ability to provide the tools - buildings, medical equipment, doctors, nurses and other skilled medical workers - that in turn will provide the top quality care, the highest goal of the hospital, Shyavitz said.

"I decided a long time ago there's almost nothing more important than creating a financially secure environment in which those who deliver health care can do it," she said. "The really important thing for the public to know is that we have really talented clinical people who are delivering excellent services. I think our clinical people do first-rate work, and it's a joy to create an environment in which they can do that."

Shyavitz said her aim is to keep those people by paying them well and keeping them focused on providing the best care.

"I want the staff thinking about the patients and not worrying about whether they can make a mortgage payment that month," Shyavitz said.

One might think that the financial acuity shown by Shyavitz resulted from an intense regimen of business and math courses at the undergraduate and graduate level.

But, not so.

After attaining her bachelor's degree in sociology at Michigan in 1968, she went on to Columbia University in New York City, where she earned a master's degree in 1970 in community organizing and planning.

Shyavitz describes herself as a "'60s kid," referring to her passion for social activism developed at a time when college campuses were highly energized in opposition to the Vietnam War and in support of an intense battle for civil rights, efforts to assist the poor, the fight for equal opportunity for women and the beginnings of an environmental movement to cleanup pollution in the air and water.

And a degree in community organizing and planning was designed to provide training for people to become "effective social activists," she said.

But for Shyavitz, the battle didn't take place in the streets.

It took place in government, which at the time was often perceived as part of the problem, rather than part of the solution.

She immediately put her education to work in the administration of New York City Mayor John Lindsay, helping to deliver a variety of human services to the people of that sprawling metropolis.

And in 1972, she moved to Massachusetts to work in the Model Cities Program in Boston, where she was in charge of planning and administering three large health centers.

That move was fateful. There, she found her career path - one that would eventually lead her to Sturdy.

"I've been in health care ever since," Shyavitz said.

But the path for a woman to become the CEO of a hospital, large or small, in those days was not an easy one, despite the efforts begun in the 1960s to improve opportunities in all areas of the business world for women.

The lack of opportunity nagged at Shyavitz and other women in the health care industry who had crucial roles in their organizations, but constantly bumped into what became known as the glass ceiling.

Promotions of women to top spots in the health care professions were few and far between, even if they had clearly demonstrated their talent.

Shyavitz and several other women, all health care executives in the Boston area, formed a group and met regularly to talk about how to change that.

They believed they were as - or more - talented than the men who got promoted ahead of them.

They decided they needed to become activists, to spark change, to cultivate a new environment, one in which they would not only be considered for a top spot, but would be hired for a top spot.

It was the early 1980s and the group was committed to change.

It eventually became known as "The A Team," a moniker created by a writer for the New York Times, which chronicled the women's efforts in a 1995 story.

"We were all critically important to the success of the institutions for which we were working, yet none of us were being suggested for CEO positions at major medical institutions," Shyavitz said. "That was a problem, and we needed to address that problem."

Their first goal was to establish at least three of their members in CEO slots within a few years.

The women quickly became organized and aggressively pursued their goal.

They made themselves known to "headhunters," people who were hired to find and recommend talented executives for positions.

They held seminars to improve their skills at reading and interpreting the financial statements and budgets of hospitals.

And perhaps most importantly, they boosted each other for jobs that opened up at hospitals.

"We were always recommending women in the group who were appropriate for the positions," Shyavitz said.

The strategy worked.

"Virtually all of us ended up running an institution or becoming the chief financial officer," she said.

Shyavitz's turn came in October 1985 - Oct. 1, to be exact.

That was her first day as CEO of Sturdy and the first day of her first fiscal year.

In her previous jobs, teamwork was a key element of success. Teamwork was also something "The A Team" employed and teamwork was something she brought to Sturdy.

Commitment to that strategy continues to this day, she said.

In her first year, Shyavitz began by seeking the opinions of key administrators throughout the hospital on the nature of Sturdy's biggest problems.

The facility was losing money and the conventional wisdom was that there were many problems.

Shyavitz said she narrowed the list to five and came up with a plan to address each over the ensuing year.

She continues to follow the same basic plan, but after almost three decades on the job, defining the problems has become easier and most of the focus is an ongoing process of solving them and becoming a better facility.

She sets written goals and objectives every year.

"If you are going to be effective, you need to keep your eye on the ball and you need to be clear about what you want to accomplish or you won't get anything done," Shyavitz said.

It's clear she and her staffers have gotten plenty done.

In 2001, there was an $8 million expansion to the emergency center.

In 2003, a $37 million expansion was begun, including a mechanical systems overhaul, construction of a new pediatric unit, a cardiac catheterizing unit and a new area for administrative offices.

And in 2009, the hospital spent another $18.6 million on improvements to the emergency center, the infusion therapy center and physical and occupational therapy areas.

The hospital paid cash for the improvements, which helps solidify its financial future because it won't carry a burdensome debt into the future.

While the achievement of financial success is the key to clinical success, the key to financial success is to "optimize revenue and aggressively manage expenses," Shyavitz said.

While it sounds like a simple formula, it's not.

A bad economy, price increases, constantly changing rules for Medicaid and Medicare, the new national health care law combined with the constant goal to improve care and safety at the hospital make maintaining financial strength a constant challenge.

While much of the revenue comes from public programs like Medicaid and Medicare, it's a battle to get reimbursed at a level that's fair, Shyavitz said.

"We have not hesitated over the years to make sure that we're getting paid appropriately by the federal government," she said.

She and the hospital have been aided in that quest by state and federal lawmakers.

The same effort is applied to private payers, health insurance companies, she said.

While some hospital services are discounted for the insurance companies - a common practice - Sturdy never discounts beyond what the hospital needs to pay for its services, Shyavitz said.

It's a constant battle, but one that has to be fought, she said.

And it's helped Sturdy stay strong financially.

Meanwhile, in the hospital's administrative offices, budgets are carefully written and monitored throughout the year in each department.

Keeping expenses under control is crucial. It's a priority for Shyavitz, and that makes it a priority for all department heads.

"Expense management starts with me," she said. "If I'm not serious about it, I can't expect anyone else to be."

Shyavitz sets rigorous standards for her top administrators and admits to being a demanding boss.

"I love being here, but it may be that people don't always love me all the time because I'm tough," she said. "But, that's what I'm supposed to do."

Shyavitz acknowledges her success has led to offers from other institutions over the years, but Sturdy is where she wants to be.

"I absolutely adore my job," said Shyavitz, who has the energy and enthusiasm of someone much younger.

The trials and stresses of running an important and complex institution do not seem to have worn her down much.

And while she has the last call on all major decisions, she didn't use the work "I" when talking about Sturdy's accomplishments.

It was always "we"

"I cannot think of a day when I was not glad to be here, working with talented, smart and committed people. I love what we accomplish here, and I love being a part of that," Shyavitz said.

In the meantime, for anyone who's meandering down the halls of Sturdy wearing Michigan colors and hears the words "Go Blue" from a highly energetic woman striding quickly by, the correct response is "Go Blue."