Carilion CEO Nancy Agee to leave position in September

Nancy Howell Agee went from candy striper to nurse to chief executive officer at Carilion Clinic over five decades. Soon she will be stepping down, the clinic announced Wednesday.

Agee became Carilion’s president and CEO in 2011 and was the first woman to run the clinic. Her final day as CEO will be Sept. 30, according to a Carilion news release. Steve Arner, the clinic’s president since May 2023, will succeed Agee as CEO on Oct. 1.

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Agee, the medical system’s seventh top executive, began her career there in 1973 and will be CEO emeritus through September 2025, focusing on matters including philanthropy and partnerships.

Agee and Arner were not doing interviews on Wednesday, according to the news release.

In a YouTube video posted on the clinic’s website, Agee said that she was born at Roanoke Memorial Hospital, the clinic’s flagship facility, and moved into the nursing school dorm there at 18. She met her husband there, and their son and two grandchildren were all born there.

“In so many ways, Roanoke Memorial and Carilion have been my home for decades,” she said, adding that “to do the work I love, with the people I love, in the place I love has been a privilege beyond measure.”

Arner, chief operating officer since 2012, has been with Carilion for a quarter-century. He led the health system’s response during the COVID-19 pandemic while he chaired the Virginia Hospital and Healthcare Association, according to the news release.

“Steve is a strong and capable leader whose commitment to our mission and deep knowledge of our entire organization make him well-suited for the CEO role,” said James Hartley, chairman of Carilion Clinic’s board of directors.

Hartley said of Agee: “Carilion and our community have been the fortunate beneficiaries of Nancy’s talents for more than 50 years. I’m grateful to her for her continued service, and I’m grateful to Steve for advancing us to our next chapter.”

Agee’s announcement came almost a week after Carilion announced that Roanoke philanthropists Nick and Jenny Taubman had given it $25 million to open a state-of-the-art cancer care center on the Virginia Tech Carilion Health Sciences and Technology campus in Roanoke.

Agee and her husband, U.S. 4th U.S. Circuit Court of Appeals Judge Steven Agee, kicked off the campaign to fund the center with a $1 million donation of their own in 2019, and with the Taubmans’ contribution, the campaign has raised more than $70 million toward its $100 million goal. Nancy Agee said last week that she hoped to break ground this fall for the building, near Reserve Avenue. Construction on the 265,000-square-foot facility will take two and a half years, she said.

Heywood Fralin, a longtime friend and colleague of Agee’s, said there is no question that the project is important to her.

“She understands that the current cancer center is well outdated and that there is a terrific need for more modern equipment,” Fralin said Wednesday. “I would certainly anticipate that it would be completed in her lifetime, so that would mean a lot to her.”

From patient to leader

Agee herself survived a cancer scare in her teenage years, and her treatment inspired her life’s work, she has said.

She first told her own cancer story publicly in 2018, when the American Hospital Association board of directors selected her as its chairwoman. Agee detailed it in a speech she gave in a Washington, D.C., ceremony that centered on her induction, according to a Roanoke Times article .

After a fall, she was taken to Roanoke Memorial Hospital and diagnosed with a bone tumor that led to five surgeries over two years. She spent time on crutches and in a wheelchair, but it enabled her to walk again.

“The extraordinary care I received as a teenager did even more than help me walk again — it also inspired me,” she said in the AHA ceremony, according to the Times.

Agee spent time at the hospital as a candy striper, so called because of the striped uniforms these volunteers used to wear. She received her nursing diploma in 1973 and succeeded Dr. Edward Murphy as president and CEO in 2011, when Murphy left the nonprofit health system for the private sector. In between, Agee received a bachelor’s degree in 1979 from the University of Virginia and a master’s in 1980 from Emory University, and completed postgraduate studies at Northwestern University’s Kellogg School of Management in 1999.

She rose as a Carilion executive on a parallel track, becoming chief operating officer under Murphy as he was leading Carilion through its transformation from a system of hospitals and primary care offices to a clinic model along the lines of the Mayo Clinic, in Minnesota, and the Cleveland Clinic, in Ohio. The changes included teaming with Virginia Tech on the Virginia Tech Carilion School of Medicine and Fralin’s namesake, Fralin Biomedical Research Institute at VTC.

While Murphy and then-Virginia Tech President Charles Steger spearheaded those changes, Agee — with Tech President Tim Sands as counterpart — carried the standard.

“I would say she brought it to a new level,” former Roanoke City Manager Chris Morrill said. “She absolutely did. And I think Roanoke is so fortunate to have — and not many communities the size of Roanoke have — leaders like Nancy. President Tim Sands recognizes the importance of Roanoke, and the two of them together have been great partners with the city, with the county, regionally, and then with other business leaders.”

Morrill, executive director and CEO of the Chicago-based Government Finance Officers Association, said that he doesn’t see that level of cooperation in many of the communities that he works with.

As that partnership was blossoming, Agee also led the clinic as it moved through the pandemic era. Fralin noted that the problems included not only an explosion of patient concerns, but the need to attract and retain personnel in an era where frontline workers were exposed more frequently to the novel coronavirus than just about any other sector of society.

“It’s been a major, major challenge for the health care industry, and Nancy has been extremely involved in finding the personnel that they needed to not only care for COVID patients but also to provide care for other patients that didn’t have COVID when there was such a shortage of health care workers,” Fralin said.

Multifaceted leader

What people are saying about Nancy Agee

U.S. Sen. Tim Kaine, D-Va.: “Nancy is a great friend, and I’m grateful for the incredible work she’s done at Carilion. The last few years have been tough for hospitals, and Nancy continually rose to the challenge, helping ensure Virginians receive high-quality care. Nancy also made Virginians proud as she served in key national leadership positions with the American Hospital Association.”

U.S. Sen. Mark Warner, D-Va.: “As the first female CEO in Carilion’s history, Nancy has overseen tremendous growth for the health system and the Roanoke community as a whole. Her five decades of service — starting as a nurse in the 1970s and working her way up the rungs to CEO — are a testament to her dedication and work ethic. Over the past few years, Nancy’s leadership has proved particularly invaluable, helping Roanoke navigate the pandemic and come back stronger. I am proud to call her my friend, and I know, even in retirement, her commitment to Carilion and the Roanoke community will continue.”

Sean Connaughton, president and CEO, Virginia Hospital and Healthcare Association: “Nancy Howell Agee personifies health care servant leadership. Her journey has been a quintessential self-made American success story from her days as a candy striper following a teenage injury and hospitalization, as the first person in her family to graduate from high school, to her work as a hospice and surgery nurse, her civic engagement on behalf of the Commonwealth and its people, her accomplished tenure leading Carilion Clinic, and her service as past Chair of the American Hospital Association’s (AHA) Board of Trustees and the Virginia Hospital & Healthcare Association’s (VHHA) Board of Directors. She leaves Carilion in the capable hands of health system President and Chief Operating Officer Steven C. Arner, a talented leader guiding Carilion to continued success. Nancy has our sincere admiration and appreciation and Steve has our full support moving forward. We congratulate them both.”

Agee’s list of board seats, past and present, is long. It features her term as chairwoman for industry advocate American Hospital Association, along with seats at the Virginia Tech Carilion School of Medicine, the Virginia Foundation for Independent Colleges, the Virginia Business Higher Education Council, the Virginia Tech Foundation and the Virginia Hospital and Healthcare Association.

She chairs the Virginia Growth and Opportunity Board, known as GO Virginia, which focuses on multiple aspects of economic development. Fralin and Ben Davenport, chairman of First Piedmont Corp. and Davenport Energy, are among her colleagues there.

Davenport on Wednesday said that he got to know and interact with Agee when he was on the medical school’s board.

“She really did a lot to maintain a very good working relationship between the university and the Carilion health system, to get that rolling, and it cranked up without a hitch,” Davenport said. “It was really a smooth startup.”

He found her to be an effective leader outside the medical setting, as well. She has chaired the GO Virginia board for at least two years, he said.

“I always say no organization rises above its leadership, and that certainly is the case with GO Virginia that under her leadership, it has really grown and has been highly effective. It’s got a lot of moving parts and a lot of different views that come from folks that are highly opinionated, and I so admire the way she’s able to make meetings flow … people agree to disagree, and it’s a real art, and she certainly has it.”

That quality speaks to her good-natured personality, Fralin and Morrill said. Fralin said he has known her for about a half-century.

“She’s always been an extraordinarily friendly and outgoing individual who people respected and who was capable and had abilities that many envy, and with justification,” he said.

She spurred excellence at the medical school, and with GO Virginia, she looked out for medically underserved areas of Southwest Virginia, Fralin said.

“I could talk about a lot of the things that Nancy has been involved in. But if there’s one message that would be important to convey, it’s that her greatest interest, while certainly focused in health care, her interest in this region is as strong as anybody I know,” Fralin said. “She is laser-focused on the economic development of this region, for the benefit of everybody that lives in it.”

Morrill was Roanoke’s city manager for seven years beginning in 2010, the year before Carilion selected Agee to lead the clinic. Her warmth, openness and collaboration marked her as a “different kind of leader,” Morrill said. That didn’t mean she wouldn’t shoot straight, he said. He remembered about three years into his tenure, he gave a presentation to community leaders about great things happening in the city.

“We had some economic development successes, downtown development, we’re reducing the crime rate, the population was growing … and so I was really excited about how we’re doing it,” Morrill said. “And I remember after, Nancy came up and said, ‘You know, Chris, you’re not doing enough.’”

She encouraged him to look at health outcomes and recognize that such figures were tied to poverty rates, graduation rates and more.

She told him: “The city of Roanoke has some of the worst health outcomes in Virginia. … If people aren’t healthy, how can you achieve anything else?”

After Agee introduced Morrill to social determinants of health, he began looking at what role the city plays. He shared data in budget briefings with the city council and moved to work with Roanoke College and the United Way, and acquire grants to deal with health outcomes.

“I think we really took that on as something that was critical, and really because of that conversation that I had with Nancy. … She would tell you what you needed to know and she did it in a very kind and appropriate way, but she definitely could get her point across, and that was an important one that I remember, and to this day as I’m out in communities, I think about the community health impact that local governments can play even in my current job.”

Looking ahead

During Arner’s time as a Carilion executive, the clinic has invested more than $500 million in facilities that include the Crystal Spring Tower addition at Roanoke Memorial — scheduled for 2025 completion — and Carilion Children’s and behavioral health facilities at Tanglewood Mall.

“Carilion today is a nationally ranked academic health system that provides an extraordinary range of services, from primary care to the most advanced, complex care,” Arner said in the clinic’s news release. “In some respects, it’s a far different organization than the one I joined more than 25 years ago. What has remained the same since the day I started is Carilion’s laser-like focus on its mission and our community, and I look forward to continuing on the path to growth and collaboration.”

Fralin said he has confidence in Arner.

“I’ve gotten to know Steve over the last several years, and I’m very impressed with him,” he said. “He’s well-liked within the Carilion system, and everything I hear about him is extraordinarily positive.

“There’s a strong belief that he will be more than capable of leading the Carilion hospital system to new and greater heights, and that’s the goal of every company, every organization, is to continue to grow and continue to improve year after year.”

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