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Edward Ashwood had led ARUP Laboratories for about two years, he said, when Vivian Lee approached him in 2011 to propose a new approach for the nonprofit enterprise tied to the University of Utah.

Lee, then the new senior vice president of U. health sciences, wanted ARUP to focus on innovation — to expand its focus beyond processing lab tests for hospitals nationwide to include creating inventions and "novel medical devices," Ashwood said.

He tried and felt he was making "good progress." But Lee called his efforts "sophomoric," he said, and, in May 2015, asked him to resign. He initially refused, but later did so to accept another position at the U. He is no longer with the university.

Ashwood is one of a number of U. health administrators who say Lee forced them out of leadership roles, moves that haven't drawn public scrutiny — unlike Lee's ouster of Mary Beckerle from her role as CEO and director of the Huntsman Cancer Institute about two weeks ago. The backlash from faculty, staff and the Huntsman family caused an uproar and U. President David Pershing announced Beckerle's reinstatement Tuesday, saying she will now report to him instead of Lee.

Lee's supporters worry the high-profile conflict threatens to undermine her transformation of the U.'s health system. Her goals — to pool finances and brainpower across departments, analyze and drive down costs and boost innovation — make her invaluable, said Ed Clark, chairman of U. pediatrics.

"I've worked with a lot of people and a lot of leaders, and I put Vivian in the top realm of the 1 percent to work with," Clark said. "She has vision and balances it with compassion and understanding. That's a rare combination."

Clark's online open letter in support of Lee, signed by 15 department chairs and co-chairs from the 23 departments in U.'s medical school, had garnered about 900 signatures on the accompanying petition as of Thursday night.

Lee declined repeated requests for an interview, but Pershing and U. officials stand behind her, saying the sprawling, multibillion-dollar health, biomedical, research and education operations she oversees are thriving. "It's healthier than it's ever been, it's growing and it continues to be recognized nationally," said U. spokesman Chris Nelson.

Samuel Finlayson, chairman of the department of surgery, sent an email Wednesday urging his faculty and staff to join him in signing Clark's petition.

"Whether or not you agree with the actions of health sciences and University leadership over the last 10 days, I hope you will agree that it harms the School of Medicine and our department to allow a distorted and negative view of Dr. Lee and our collective accomplishments under her leadership to persist in the public eye," he wrote. "I am hopeful that this letter will aid in the important work of healing the rift we have recently felt at the University of Utah."

But Catherine R. deVries, a professor of surgery and pediatric urologist, sees Clark's call in the open letter for "stakeholders and appreciative colleagues" to sign the petition as unwanted arm-twisting. The culture of trust at the U. has deteriorated under Lee, she said.

"Is this what we want for our faculty, to always be looking over our shoulders to see whether we will be the next to go?" she asked. "This is not the way toward sustainable excellence."

Facing challenges • In the days between Beckerle's firing and reinstatement, Jon Huntsman Sr. — who founded and has donated hundreds of millions to the Huntsman Cancer Institute — criticized Lee as "vicious" and called for her firing. Ousting Beckerle was a "power grab by an unethical and dishonest Vivian Lee," he said, adding that he suspected Lee wanted to control the institute's cash reserves of more than $30 million.

Angry faculty and staff from the institute chanted, "Hey hey, ho ho, Vivian Lee has got to go" as Clark met with them the day after Beckerle's firing. More than 3,700 people have signed an online petition objecting to her removal.

But Clark and the department heads see Lee as "imperative to the continuing success and strength" of the U. They posted their letter and petition to make it clear that Lee is a "extraordinarily innovative and visionary leader" who has been portrayed unfairly, Clark said.

The open letter warns, "If we let the commentary and mis-characterizations of the past week go unchecked, our institution, reputation, and leadership will be damaged beyond repair."

Before Lee arrived at the U. in July 2011, health sciences "historically was run at the level of the chairs and departments," he said.

But Lee has spurred the departments to work together, he said. "Over the last one-and-a-half to two years, there has been a sense of singular purpose."

This is rare in academic settings, Clark said, because departments usually are looking out for their own interests and are unwilling "to share resources appropriately."

But unity makes the system stronger, he said. For example, outpatient services or rheumatology don't generate much revenue, he explained, and distributing income from other areas helps those key services operate.

Collaboration also helps health systems find efficient ways to provide better care at a lower cost, he said, a challenge as providers shift to charging a "bundled" amount for a procedure, rather than the traditional fee-for-service model that pays providers for ordering more tests and treatments.

Lee has focused on analyzing costs against outcomes, and using that data to standardize and improve care while shaving unnecessary expenses.

The U. is implementing integrated practice units, Clark said, connecting doctors and others from multiple departments to tackle problems or conditions. In one example, cardiologists, surgeons and others are working together to improve care for heart failure, he said.

Since arriving at the U. in 2011, U. officials note, Lee has boosted the number of medical providers from 1,000 to 1,400, brought two new community clinics online and increased the flow of grant money to $288 million from $100 million.

Robin Marcus, tapped by Lee as interim dean of the College of Health in 2013 and now chief wellness officer at the U., said Lee — a leading radiological researcher — not only has a strong science and academic background, but also is a compassionate and caring leader who understands the business of health care.

"We are in a unique position in that we have both an academic system, as well as a health system and they can integrate," she said. The scope of Vivian Lee's vision requires uncomfortable decisions, said Thomas Lee, chief medical officer at Press Ganey, a health care consulting firm, who is not related to her. He co-wrote an editorial in the September Journal of the American Medical Association that said the U.'s transformation shows "achieving better quality and lower costs is possible, and everyone can benefit: patients, hospitals and physicians, and society."

"Improvement means change and change means making people upset," Thomas Lee said in an interview, adding that Vivian Lee has been willing to do that.

"If nothing changes in the structure of what people are doing, probably nothing changes" at all, he said. With change, there "will be some folks whose portfolios increase; others will change in a way that's worse for them."

'Go back to the lab' • A few weeks ago, as his latest research paper was set to publish in Nature magazine, neurologist Stefan Pulst was called into Vivian Lee's office.

Pulst, chairman of the U.'s neurology department for the past 10 years, said Lee told him "it's a good time to go back to the lab" solely as a faculty member, he said.

He was surprised.

"I thought there was some unhappiness between Vivian and me," Pulst said, "but I thought we both had actually dealt with it in a reasonable way and forged a path forward."

Last fall, Lee was concerned about the level of philanthropy received by the department, but she routinely told him he was one of her "best chairs," he said, so he had expected his contract to be extended.

Soon after Lee's arrival at the U., he said, he had noticed that she seemed to be firing department chairs she had not recruited. So he negotiated a five-year contract, which ends Sept. 30.

He also notes a five-year review of his department, "usually done by a committee of outside neurology chairs to give the [senior vice president] an unbiased view of the chair's performance," was not done before his removal. "Thus, it appears that she makes these decisions non-consensus based," he said in an email.

Lee sent an email to the department April 13, announcing he will be returning to faculty Oct. 1 and praising his work to reorganize the department and grow the size of its faculty, number of residents and research funding.

In a foreshadowing of the outcry about Beckerle days later, outraged members of his faculty asked that the decision be reconsidered, calling his performance "outstanding" and highlighting his accomplishments in a letter to Lee.

"I genuinely do not know how we will find a replacement for him," said K.C. Brennan, a U. associate neurology professor. "Quite simply there is no one of his stature that is not already running an even larger or more prestigious department."

Lee's email to Beckerle, removing her from her CEO role, did not give a reason for returning Beckerle to the faculty.

Other administrators removed by Lee also said they were surprised by their sudden demotions and didn't feel the underlying reasons for the decisions were explained. They also felt Lee's communication was unnecessarily harsh.

DeVries shares that concern.

"Dr. Lee has been right to promote Utah as exemplary for value in patient care, and I do believe that she intends to foster collaboration," deVries said. But, she added, "Since she arrived, Dr. Lee has often been dismissive and sometimes actually cruel to many faculty members who did not acquiesce to her vision of transformation."

Nelson noted that Lee "continues to recruit remarkable new faculty members."

'The way it was done' • Rena D'Souza, the first permanent dean of the U.'s new School of Dentistry, was caught off guard by her demotion, she said, and felt the decision lacked due process.

D'Souza said Lee recruited her to run the dentistry school beginning in fall 2013 as the school was enrolling its first students. By October 2014, Lee told D'Souza she was out as dean and would remain a faculty member, according to an email from Lee to the school's faculty.

In D'Souza's termination letter, Lee wrote that "it is clear to me that you have not been able to meet the expectations we have discussed over the past year and are not suited to continue as dean."

Lee didn't elaborate on what expectations she failed to meet, D'Souza said. Lee and other administrators had praised D'Souza, she said, for her fundraising, curriculum development and faculty hiring in the short time she was there. That's why the dismissal came as such a surprise, she said.

In a letter to Lee and Pershing, five professors at the dental school asked for an investigation of D'Souza's firing, objecting that faculty had not been consulted about her performance, and it appeared the usual administrative review process was bypassed.

The process "smacked of an amateur handling of delicate matters and a complete failure to exercise leadership, when it mattered the most," D'Souza said.

Lee, who also serves as dean of the U.'s medical school, has hired D'Souza's replacement and the remaining three deans in health sciences. She also has replaced department heads and other administrators.

Like Pulst, Ashwood at ARUP felt he was moving in the direction Lee wanted — taking bigger risks and embracing innovation. She had approved his bonus months before personally requesting his resignation in May 2015, he said. He had "six major, risky projects, already underway," he said, and during his last year as its leader, ARUP grew its revenue 8.7 percent, to $503 million, and distributed $57.5 million to the U.

He now works as director of clinical laboratories and professor and vice chairman for clinical pathology at the University of Colorado's Anschutz Medical Campus.

Richard Sperry said he was "blindsided" by Lee in 2012, when he was the U.'s associate vice president for academic and clinical affairs.

They were scheduled to discuss how he wanted to focus more work on economics and health policy at the Matheson Center for Health Care Studies. But Lee unexpectedly told him "it was not going to work for me to be on her team going forward," he said, after he had served 14 years in senior administrative posts.

She said Sperry was "too thoughtful and deliberate," he recalled. "She preferred to have aggressive, in-your-face members of her leadership team."

Sperry, who now is a professor and vice chairman in the anesthesiology department and president-elect of the University of Utah Hospitals and Clinics medical staff, said he was confused.

"I asked if she was unhappy with either the quantity or quality of my work and she said no — she even offered words of praise for my past contributions," he said.

Sperry said he's happy in his new role and acknowledges that it's not unusual for a new administrator to make changes in her leadership team — but "her methods seem harsh."

"I really couldn't complain about her decision even if I didn't agree with it," Sperry said. "I only have ill feelings about [the] way it was done."

Editor's note: Paul Huntsman, the son of Jon Huntsman Sr., is the owner and publisher of The Salt Lake Tribune