Delia Basden's modesty probably wouldn't let her shout it from the rooftops, but she has been instrumental in a financial turnaround at a major institution in Bermuda many people thought would never happen. As chief financial officer of the Bermuda Hospitals Board (BHB) she and the current Board of Directors can rightly feel some satisfaction at the organisation's reported net income of $6 million for the year March 31, 2004. This result was a significant improvement on the loss of $3.5 million recorded for the previous year, and was achieved primarily because of an emphasis on strong financial leadership by the Board, implemented under the management responsibility of Ms Basden.

"In the last five years we've run things more like a business, even though it is a healthcare facility," says the 40-year-old mother of two boys Tariq, 6 and Terrell, 4. "There's certainly been a more business-focus, and we have people on the Board with that background who provide great direction in that regard. In the past the thinking tended to be that because it's a charity we shouldn't make money, but now we have to think about money much more to ensure our future viability and in order to fulfil our primary mandate of providing the best healthcare for patients that we can."

And to think the accounting profession might at one time have lost her to law.

She originally thought she would become a lawyer, even after she chose to do an accounting degree because she was very good at maths throughout her studies at the Bermuda High School, Saltus Grammar School and Bermuda College.

"I actually thought I'd do the accounting degree and then go to law school," she says. "But I basically fell into accounting because of my strong math and analytical skills."

After graduating from Andrews University in Michigan in 1986, she put those skills to great use during a varied and busy career, while also qualifying as a Certified Public Accountant in 1989 and achieving her Chartered Accountant designation in 1990. Her first job after returning to Bermuda from college was with Coopers & Lybrand, after which she joined another accounting firm Christensen & Davis, both in auditing positions.

"But I didn't intend on having a career in an accounting firm," she says of her decision not to pursue the ultimate goal of eventually becoming a partner.

"The higher you got, the more focus there seemed to be on exempt companies which involved more paperwork and less people contact. That didn't interest me; I like working in an environment with real, day-to-day issues, real people, it's more stimulating and more interesting."

With her focus on the domestic business sector, she subsequently worked in two local companies ? Purvis Ltd. and TheRoyal Gazette ? prior to becoming the financial controller at the Department of Airport Operations.

She was appointed to her current position in 2000, overseeing all the financial matters of the BHB, a challenging task given the troubled history of the hospitals in terms of their finances over the years.

"There was no steady growth over a period of years and we've had a major loss since I've been here which was related to some significant costs that basically were not budgeted for properly before," she says.

"It was a wake up call for us all and we were determined it wouldn't happen again. So we implemented measures that would lead to greater financial accountability at all levels; we've all been involved in this process, me, the directors, management and staff."

And according to Ms Basden this new approach along with tighter financial controls has been paying off.

"We started an education process on the financial side of things with the staff in earnest about two years ago," she says by way of example. "It was actually made mandatory for some levels and the point was to help staff link what they do to the macro level financing and what it takes to run the hospital. The feedback we're getting is that people are being more mindful of money and costs in their everyday jobs.

"So education internally has been key to making progress, along with stringent controls being put in place."

Other steps that have helped improve the financial situation at the hospital recently included the refinancing of bonds issued in 1998 which resulted in savings of half a million dollars last year. "It had the impact of reducing our interest expenses, so it did help," says Ms Basden. "We basically took advantage of the lower interest rates. Those are the types of ways we are constantly looking at our operations to see what we can do better."

She feels that the hospitals are "99.9 per cent misunderstood" by the public, but also that that situation is not surprising.

"It's not an easy organisation to understand if you're on the periphery; I didn't understand what's involved in running the hospitals until I worked here," she says. "In terms of finances there's a lot of misunderstanding, especially about what we really need. And people don't understand that all the issues we have, other hospitals around the world also have.

"The costs of providing technology, keeping up-to-date, staffing, maintenance, we're being asked to do more with less," she continues. "Healthcare inflation is currently about three to four times higher than general inflation; that amounts to about 16 per cent right now. The Ministry of Finance has to approve our fee increases, which have averaged about five per cent in the last two to three years compared to our costs increasing by ten per cent during the same period.

"So we're facing increasing costs and constrained revenues, and all hospitals today are dealing with this issue. It just means it's up to us to look internally and work smarter."

But there are also plans to implement new ways to generate some increase in revenue. According to Ms Basden, of the $150 million budget that covers both hospitals, in the next fiscal year $60 million will come from the Government for King Edward VII Memorial Hospital.

"That goes to subsidise certain groups of patients, such as those under 16, certain seniors, the uninsured," she explains.

Other revenue for the hospital must come from insurers and other patients, while St. Brendan's receives a grant of $27 million, which covers about 60 per cent of that institution's operating expenses.

"We're looking at introducing a new chargemaster system ? basically our list of fees ? that will impact our revenue," says Ms Basden. "Currently patients get charged a daily rate and no additional fees; an in-patient could have one surgery or 20 and pay one rate. We're looking at changing that so that there will still be a per diem but also charges for services you receive at the hospital, diagnostic services and surgeries.

"It will cost more, but we're currently doing the due diligence, checking the numbers and balancing everything out to ensure that it's not a huge increase. The insurers have been briefed and I'll be giving a presentation about this at the Health Summit in two weeks time. We don't want to gouge anyone, we're just trying to recoup costs, and this is critical to implement for the hospital to keep going and to meet the targets we've set for ourselves."

There are rumours that one major target is fundraising in the millions of dollars for a totally new hospital facility, which will be presented to the community by the Bermuda Hospitals Charitable Trust (BHCT) as a capital campaign later this year.

"I meet with the BHCT Finance Committee periodically to discuss future funding issues; after the estate master plan being developed right now is finished around about May or June we'll all have a better idea of numbers involved," says Ms Basden. "The capital campaign is significant; it will help to take us into the next 15-20 years and beyond."

As the hospitals continue to go through this significant period of transition, her position means that she is involved in many different projects and committees which keeps her both busy and stimulated.

"We've got some very aggressive strategies we want to implement and we seem to want to implement them all at once!" she says laughing. "We do find ourselves stretched at times because the community's expectations are high, and we want to meet or even exceed them when we can. There's never a dull moment and my own knowledge is constantly being expanded, especially on the clinical side.

"The medical field itself is exciting and in an organisation like this you can't just be an accountant," she adds. "The environment changes so rapidly, the technology, medical issues, recruitment issues; you must keep up with what's going on in Bermuda and worldwide. I think anyone who works in an environment like this likes that variety and ultimately feeling like you're making a difference."