After nearly six years at the helm of the Guam Memorial Hospital as its administrator and CEO, Lillian Posadas is preparing to retire.  KUAM News sat down with Posadas to reflect on her tenure, the challenges faced, and her hopes for the future of healthcare on Guam.

A former registered nurse, Posadas began her tenure leading GMH in January 2019.  As she prepares to retire at the end of this month, she says she’s thankful to the governor for trusting her to take on the position – one she never took lightly. From the start, Posadas says her goals centered around people.

 “When I first came into this position the three things that I was really looking at was employee development and training," she expressed. "Just to get the employees comfortable in some skills to carry out their duties – whatever level that they’re in.”

“The second goal that I was aiming to achieve was recruitment of young people. Not to discriminate against the senior people, but those who are young, who have potential, especially in leadership roles here at the hospital, and with the caliber of critical thinking and communication skills, and talent. Succession is what I was really thinking to have that line for individuals who feel comfortable, that they have the knowledge and the skills, and the attributes – even the attitude – to really be leaders of this organization because it demands a lot.”

After just over a year into her leadership, the unexpected happened. She recalled, “I started in January 2019 and we had in 2020 the pandemic. That was really a very,very tough time. There was so much uncertainty, so much fear, and just anxiety about how we were going to deal with the individuals and take care of them knowing that the condition they have is very contagious, very infectious.

“We didn’t really have much of a capacity here with regards to making sure that we keep them isolated with a negative air pressure. But we had tremendous support and help not only from our local community, but from private sectors, the Governor’s office, Homeland Security, from the military. That was a very, very tough year – very challenging years, but we pulled through. We pulled through. Yes, unfortunately we lost some lives and that was traumatic for our staff and the families, but there were also others who we saved.”

Beyond recovering from the pandemic and the damage sustained from Typhoon Mawar, finances have been the hospital’s most persistent struggle over the decades. “The greatest challenge was the finances, the underfunding of this hospital," she said. "It’s our only government, public hospital, but we continue to be underfunded. And the reimbursement rate. From the insurance, the federal Medicare,Medicaid, the reimbursement rate is never 100%.”

She says unlike a restaurant where the bill is always paid in full – sometimes accompanied by a kind tip – GMH isn’t always 100% reimbursed for the services they provide. “And then when we go before the Legislature every year, even though we request – like last year for Fiscal Year 2025 we requested about $74 million – we didn’t get that. And so, that was really quite a challenge," she explained.

Recently, a $40 million appropriation was signed into law to help GMH meet immediate needs. Posadas says payments to vendors have already begun, saying, “We want to make sure that we pay our vendors. We’re so thankful that the vendors understand. Also, we understand their position, that they have their employees to pay, the goods and supplies that they bring into Guam for us when we need it. They honor us knowing that eventually they will get paid.”

But funding isn’t the only obstacle. 

From nurses and doctors to accountants, coders, and billers — shortages across the board continue to stretch the hospital’s workforce. “The people that we have on board, they’re so committed and dedicated to what they do and they get the work done as best as they can," she continued.

Walking through the halls of Guam's only public hospital makes it clear — the facility is showing its age. From leaky ceilings to outdated infrastructure, it’s a facility that Posadas herself admits is in crisis. Even so, she points to specialty services like gastroenterology, cardiology, and pulmonology as evidence of progress, despite the building’s limitations.

And for those who may doubt GMH, Posadas has this message: “I’d like for them to have a better, clearer understanding of what goes on here within the walls of the hospital, the many challenges, and that the staff give their hearts and souls to provide service that [the public] deserves.”

 “We don’t turn people away. We welcome them to come and walk the hallways of our hospital, see how it is, to not be afraid, to not worry, because they will be taken care of.”

As for her parting words for the team that has stood by her side, she offered, “We’re all here for a purpose and that is our Lord God’s glory. We are here to serve the patients that come here and need our services, our care. We also are here to serve each other, to work with each other because when we work with each other – I’ll tell you – it’s amazing what we can accomplish together.”

Looking ahead, she hopes the next administrator will bring both expertise and creativity to lead the hospital forward, as well as closer to achieving accreditation. “I hope that they will be open-minded, that they will continue to take the hospital to a higher level of performance of excellence and quality.

“And has a young, creative, innovative mindset to say, ‘Hey, let’s think out of the box. Let’s try another solution, another way of doing things,’”

For every challenge, for every comment made, Posadas says there have been blessings along the way, noting, “Despite all the criticism, despite the attacks – it’s not about Lillian Posadas or for Lillian Posadas. It’s for the people of Guam who come here because they need to come here.”

 “That’s always been my commitment. I’m just very fortunate, very blessed that the Lord has given me this opportunity.”

Her last day will be on September 30, but the work of the Guam Memorial Hospital continues. For Posadas, the legacy she leaves behind is not measured only in policies or budgets, but in the people who carry on the mission.

And in the belief that a stronger, more resilient GMH is still possible.