EXCHANGE
HCE
Real Issues : Real Solutions
Baptist Health System Turnaround in recession
JAN/FEB 2011
HEALTHCARE EXECUTIVE EXCHANGE MAGAZINE | www.hcemag.com
Real Issues : Real Solutions
CONTENTS
06 Baptist Health System
IN-FOCUS STORIES
Mission and Values guide turnaround at Baptist Health System
10
Children’s Hospital Boston
14
Memorial Hermann, The Woodlands Hospital
18
SSM Health Care of Wisconsin
22
Children’s Hospital Eastern Ontario
25
Kingston General Hospital
28
Fauquier Health
30
Flagstaff Medical Center
32
GW University Medical Faculty Associates
34
Huron Perth Healthcare Alliance
36
Interior Health Authority
40
Mountain View Regional Hospital
42 Parkview Hospital
HCE EXCHANGE
JAN/FEB
2011
44
Piedmont Fayette Hospital
46
San Jacinto Methodist Hospital
48
UTH Science Center at San Antonio
BAPTIst Health System
“As a team, leadership held focus groups to find out
improved physician satisfaction. All this through the
what our values meant to employees in the context of
lowest point in America’s recession.
the workplace and performing their daily roles.”
“We are really trying to challenge ourselves to think
Baptist Health System includes four hospitals, 40
In the face of healthcare reform, tightening costs and coordinating independent and hospital-employed physicians, healthcare systems are seeking innovative ways to provide care and create a positive environment for employees. Baptist Health System in Birmingham, Alabama, chose to use the organization’s mission and values to reinvigorate the process of providing care, improving quality indicators as well as finances.
healthcare,” Spees said. “We have to step back and
as well as nine senior housing facilities. The organiza-
look at where we have opportunities to change the
tion’s mission incorporates its values as guidance for
way we provide and manage healthcare. We’ve chosen
providing care and establishing goals: As a witness
to approach this as a team, which is not easy. It was
to the love of God, revealed through Jesus Christ, the
a cultural shift for us as an organization.” With about
Baptist Health System is committed to ministries that
4,300 employees in the organization, redefining the
enhance the health, dignity and wholeness of those
working culture was no small task.
we serve through Integrity, Compassion, Advocacy, Resourcefulness, and Excellence. Using this mission as a guide, Baptist went from
“As a longstanding, faith-based organization, we have a rich history and strong mission,” said Shane Spees, President and CEO. “I made an effort to meet with employees, physicians, business owners and others to get an impression of where we stood in the market and find opportunities for improvement. I noticed that we weren’t living out a strong sense of mission daily.
innovatively and differently about our approach to
physician practices, independent physician locations,
Importance of leadership and teamwork
having operating losses of around $25 million in 2007
Baptist took a team approach to developing goals and
to operating income of almost $2 million in fiscal
changing the culture, with the System’s mission state-
year 2010. The System also made progress in operat-
ment as their guiding principle in all changes.
ing and clinical quality indicators over the past three
“In a team-based approach, we all understand
years, performing in the top 10 percent nationally
we’re responsible for our goals,” Spees said. “We all
in many areas. In addition, the health system has
have individual targets and objectives to reach, but we
HCE EXCHANGE MAGAZINE Real Issues : Real Solutions
7
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formulate our plans in a team environment. We also
and human resource leadership systems, which
He also said the system just broke ground on a project
have critical success factors at the System level: mis-
included investing in leadership tools and coaching.
at its largest hospital—Princeton Baptist—to renovate
sion, excellence and engagement. All planning we do
With strong leadership, Baptist was able to focus on
90,000 square feet of existing space and add 60,000
relates to those success factors.“
employee and physician engagement and improving
square feet. The project is estimated for three years,
Using the critical success factors, which relate back to
the work area to meet the needs of employees
and Spees said when complete, the hospital will have
the health system’s mission and values, keeps align-
and physicians.
the “most modern technology in operating procedural
ment throughout all facilities and helps balance the
rooms available.”
decision-making process. Whether it’s decisions on
Next steps
capital investment or services expansion, leaders can
With the employee culture and finances improved,
the implementation of an ambulatory electronic medi-
look to the success factors to ensure their decision
and quality measures on the rise, Baptist Health
cal record throughout employed physician practices
fits within the System’s strategic plan, Spees said.
System is now looking toward modernization and
and independent physician practices that have chosen
improving technology.
to contract with the System. Spees is looking forward
“The team-based approach has fostered a culture not just of teamwork, but also of system-wide ac-
“Recently we invested about $150 million in
Another exciting investment for the System is in
to a future with the community’s hospital and ambula-
countability,” Spees said. “We’ve made sure our plans
modernizing the internal workings of our hospitals,”
are aligned and cascade those targets down to indi-
Spees said. “That includes investments in medical
vidual goals and objectives for different roles through-
technology, medical equipment, new cath labs, new
tant to be persistent in pursuing your goals and being
out the system, not just across management.”
operating rooms. We also recently opened a new pa-
mindful of your organization’s overall mission. It’s not
tient tower at Shelby Baptist Medical Center, which
just what you accomplish, but how you accomplish it
critical to the System’s success. He said the health
features all private rooms and doubles our critical
that matters.”
system began re-engineering its operating systems
care capacity, which was a real need in
Spees said investing in leadership has also been
that community.”
tory settings connected through this technology. In accomplishing all this, Spees said, “It’s impor-
By Patricia Chaney
HCE EXCHANGE MAGAZINE Real Issues : Real Solutions
9
02 | Children’s Hospital Boston
Children’s Hospital Boston
Land in Boston is at a premium and construction in the city’s Longwood Medical Area, among the densest healthcare centers in the world, comes with a price tag that computes to $150,000 an FAR foot (based on the floor area ration that can ultimately be constructed on a particular site). Children’s Hospital Boston sits alongside healthcare giants such as Harvard Medical School and School of Public Health, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, and Beth Israel Deaconess Medical Center. The 392-bed hospital is the premier pediatric medical center in the nation.
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Charles Weinstein, Esq., Vice President for Real Estate, Planning & Development, is responsible for coordinating the Institutional Master Plan for the hospital with the city of Boston. It is a plan that gets updated every two years and it tells the city of Boston’s redevelopment agency what Children’s is then planning, in terms of its strategic needs, what buildings it is planning on constructing, and the nature, size, and description of those buildings.
ing $50 million in renovations. Additional outpatient
thoroughly analyzing all of the implications for shut
clinics are under construction as well , each located in
downs and how it affects adjacent properties or adja-
suburban ‘satellite’ locations.
cent programs, that’s what causes problems. I’m all
“Everything is derived from our institutional master plan,” says Weinstein. “We spend a lot of time
about two years in planning and approval with an ad-
to provide to the hospital over a period of years….
ditional three years in construction.
creating individual capital projects that are designed
The Evolution of Healthcare Real Estate and Development
to further the goal of that plan.”
“Years ago, what I am doing now was done by a
space or more research space. We then implement that agreed upon strategy in a variety of locations, by
Architects are selected through a kind of jury
mechanic or plumber and worked himself into a
but everyone is carefully screened before they are
supervisory role. He was basically doing renovation
allowed to work at Children’s Hospital Boston. “We’re
jobs,” says Weinstein. “I’m an attorney with a Master’s
too big and the kids are too sick to allow anybody to go
degree in arts and architecture. I think it’s all become
to school on us. We want very seasoned, experienced,
much more professional in the administration of
skilled contractors and workers, whether it’s within
capital projects. The stakes are too high for both the
the direct construction trades, or by providing the
patients and the Hospital.”
and architectural fields,” says Weinstein.
The Key is in the Planning
ensures that our projects remain safe for patients,
Building Up for a Better Tomorrow
staff and visitors. For over 44 years we have proudly
One of Weinstein’s current projects, slated to be com-
worked at Children’s Hospital Boston, where we are
pleted in 2013, is the lateral expansion of the 10-story
privileged to play a small role in building a better
main hospital. They are building up, floor by floor,
tomorrow for the kids.
because there simply isn’t enough physical space in
Our extensive experience working within hospitals
facilities director who grew up as an electrician or
selection process. Contracts are all competitively bid,
hospital with professional services in the engineering
tion manager with a focus in Healthcare and R&D.
Real estate projects of magnitude general take up
trying to figure out strategically what it is we need whether it’s more inpatient beds, more outpatient
G. Greene Construction is a full service construc-
about the planning.”
“All of my colleagues come from different disciplines. Some were architects; some were in a construction background and got into hospital construction. I’m not sure there is a best path, but there has to
“The success of any project comes in the planning
be an understanding of how hospitals operate. Getting
effort,” says Weinstein. “If you plan it well, test all
a masters degree in healthcare administration is use-
your assumptions, and have a good architect, the
ful, but it’s not a silver bullet to getting into this role.”
implementation gets to be pretty easy because it’s just construction. If you rush into construction without
by T.M. Simmons
Boston to build any other way. Because they can tie into the existing building there will be fewer space redundancies. Existing lobbies, elevators, and storage spaces will be used. The 120,000 square foot addi“We go through a building by building review process before anything is constructed in Boston,” says Weinstein. His department is also charged with buying or leasing property to facilitate expansion of the hospital’s footprint. They create satellite locations which allow them to bring outpatient care, and sometimes inpatient care, closer to the patients, so that family life, when possible, is not so disrupted by an illness. The organization also acts as a landlord, in some cases, to both healthcare businesses and other types of services or industry.
tion will add space to the emergency department, the radiology department, and add recovery beds to the operating suites. Then, they are creating additional floors of inpatient beds and a new neuroscience floor for advanced radiology. The entire project is expected to be complete in the summer of 2013 at a total cost of $168 million. Weinstein is also working on a number of small renovation projects or upgrades. Three different research buildings, totaling more than a million and a half square feet of laboratory facilities are undergo-
HCE EXCHANGE MAGAZINE Real Issues : Real Solutions
13
03 | Memorial Hermann, The Woodlands Hospitall
East Tower Expansion The Woodlands Hospital recently broke ground on the new $80 million, seven-story East Tower. Phase one of the 240,000-square-foot expansion will add eight state-of-the-art surgical suites and surgical support services, including pre-operation and recovery rooms, waiting areas and a new sterile processing center. The expansion will also include the renovation of the existing hospital surgical suites.
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Memorial Hermann, The Woodlands Hospital
Fighting Cancer, One Slide at a Time.
The largest not-for-profit healthcare system in the state of Texas is Memorial Hermann Healthcare System. One of the top performing eleven hospitals in the System is Memorial Hermann The Woodlands Hospital which has provided high quality, patient- and family-centered care since it opened its doors 25 years ago in 1985. It is a 252 private bed hospital located north of Houston in The Woodlands, a master-planned community. Memorial Hermann The Woodlands provides the highest level of trauma care in Montgomery County and is also the only hospital in the county to be granted Magnet® status for nursing excellence by the American Nurses Credentialing Center (ANCC) nursing’s highest honor with just 6% of hospitals in the country having this designation. Additionally in 2010, HealthGrades ranked Memorial Hermann The Woodlands, part of Memorial Hermann Healthcare System, among the top 1% of U.S. Hospitals.
Real Issues : Real Solutions
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The current expansion marks the third major expansion project undertaken by Memorial Hermann The Woodlands in the past decade. In addition to the West Tower expansion, a third medical office building was
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opened on campus in 2005. Last year, Memorial Hermann The Woodlands opened 24-HR Emergency Care, a community-based emergency services facility with
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onsite lab and imaging services. They also established
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an ongoing relationship with Memorial HermannTexas Medical Center, Children’s Memorial Hermann Hospital, Mischer Neuroscience Institute and the University of Texas Health Science Center.
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“We continue to invest in our future to meet the growing needs of our community,� says Urban. “We are well on our way to accomplishing our vision to bring a medical center level of care to the communities we serve.�
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Best Practices Driving Efficiency “We have best practices that guide the look, the feel, the colors, the selection of artwork, and the interior layout. By being part of a large system, we have stronger buying power and efficiency through standardization to help keep our costs down,� says Patrick Shay, Director of Engineering and Security.
“We have reached capacity several times in the past
Operational efficiency examples include the
five to ten years leading us to turn patients away because there is not a bed available for them,� says Josh Urban, Chief Operating Officer of the hospital. “The
It became a total redesign of the way patients flow
greater Montgomery County area is one of the fastest
and the way operations run in the emergency center
get together every two weeks with the entire senior
works together, communicates and produces great
growing areas in the U.S. and it is our responsibility to
and as a result, these processes changed across the
management team at a meeting led by our CEO,
results.�
continue to respond to that growth not only with facili-
entire System.
Steve Sanders. There, we discuss patient satisfac-
ties like the new patient tower, but also technology and a higher level of services.�
A History Rich in Growth Since 1991, Memorial Hermann Healthcare System has invested more than $180 million on The Wood-
highest in the system. In physician satisfaction ratings
performance, The Woodlands Hospital comes out as
successful improvement of Emergency Center flow
last year, Memorial Hermann The Woodlands was in
one of the best performing hospitals in the System.
processes at Memorial Hermann The Woodlands.
the 86th percentile nationally.
Another example of corporate efficiency is an
“The managers and directors in this hospital
tion results, including our recent scores and specific
energy consumption reduction initiative resulted in
survey comments,� says Urban. “Leaders from the
system-wide savings of more than $3 million in utili-
different departments talk about what areas need
ties and resulted in two hospitals in the system receiv-
improvement. We also end up talking about employee
ing the Energy Star Award.
satisfaction and put equal diligence into physician
Collaborative Efforts Reach Positive Outcomes
West Tower in 2003, they included additional floors of
“One thing I’m very proud of for our facility are the
we can support one another in ways to improve scores
shelled space which were later built out to accommo-
patient satisfaction ratings each year. Memorial
through better processes. As a result, we have seen
date two floors of patient beds. In the new East Tower
Hermann The Woodlands is among the top scoring
great improvements in turnaround time for services
expansion, four floors of shelled space will be ready to
facilities in the Houston area,� says Urban.
that require lab work and/or and imaging – and our
meet future needs for additional inpatient beds, physician offices or post acute services.
In addition, the employee satisfaction results for Memorial Hermann The Woodlands are among the
ment work,� says Urban. “We have a strong team that
by T.M. Simmons
satisfaction.�
this dynamic market. When they built the six-story
lands Campus to respond to the growth and needs of
“We do a lot of multidisciplinary, or multi-depart-
“The best thing about that meeting,� says Shay, “is that we are bringing departments together so that INDUSTRY PARTNERS GKL Health Services www.gklhealthservices.com
patients and staff are responding positively.� When satisfaction scores are matched with financial
HCE EXCHANGE MAGAZINE Real Issues : Real Solutions
17
04 | SSM Health Care of Wisconsin
SSM Health Care of Wisconsin Managing the construction of healthcare facilities is a balancing act of budget and flexibility, according to Rick Stoughton, Director of Project Management for SSM Health Care of Wisconsin. “If you design too much flexibility into a space you will be way over budget, so you’ve got to pick and choose the areas where you want to be flexible. We’ve got to be good stewards of our resources and keep healthcare costs down,” he says. SSM Health Care owns and operates 2 hospitals and is affiliated with 5 hospitals in Wisconsin which gives Stoughton plenty of opportunity to practice his balancing act. His top projects for the moment include a new $150 million free-standing hospital and clinic in Janesville, a critical access replacement hospital in Edgerton, and numerous remodel projects in Madison and Baraboo. The greater organization of SSM also has acute care hospitals in Illinois, Missouri, and Oklahoma.
Project Highlights The biggest project on Stoughton’s agenda right now is a 158,000 square foot freestanding hospital and 160,000 square foot clinic in Janesville, Wisconsin. The total cost of the two buildings is roughly $150 million. “It’s a high tech facility, with state of the art features,” says Stoughton. “It’s pretty much a steel composite structure with brick, glass and stone on the exterior and has a very warm feel thanks to the many features such as wood, fountains, and stone detailing on the interior.” SSM likes to incorporate as many sustainable elements into the construction and design as possible, but they don’t strive for LEED certification. “As an organization, we feel that putting the dollars toward the energy efficient items versus the paperwork and the plaque on the wall is more beneficial,” Stoughton says. “We’re doing a number of energy efficient design features such as heat recovery wheels and chillers, along with some other fairly substantial energy items,” he says. “We look at ways to save energy and recycle materials. That’s the biggest trend I see in hospitals today and I’m all for it. We’re putting things in that make sense, like a bus route to the front door. It doesn’t cost as much, and it makes sense to promote alternate
HCE EXCHANGE MAGAZINE Real Issues : Real Solutions
19
contractor, but we have our preferred list and a lot of the time the same guys are winning the work. As a system we are required to bid all major projects it out each and every time, and the contractors understand that they’ve got to sharpen their pencils, each and every time.” A good contractor, in Stoughton’s book, is also very safety conscious. “When you are in the medical industry, patient safety comes first, and some of that goes all the way back to how you design and build the space,” he says.
The Evolution of Hospital Construction “Hospital projects today are very complicated because of the technology and the sophisticated equipment that goes in them,” says Stoughton. “We’ve constantly got to keep thinking of the new technologies that are around the corner and not box ourselves in. The technology of tomorrow will be a lot different for specialty rooms like operating rooms and MRI’s. We’ll look at what the technology is evolving to and a lot of times we’ll size and setup the room for future technology. We’ll sometimes put in the back boxes for those technologies of tomorrow that aren’t quite here, or those technologies we just can’t afford yet, but we know we want to install in the near future. We’re constantly looking at the potential future upgrades and designmodes of transportation. If it’s under a five-year pay-
A lot of that is evidence based. We take a number of tours
and get the design fully baked, so to speak, the better
back, we’re definitely putting it into the project.”
to settle on the design and layout that best fits our needs
off you are when it comes to change orders and cost
based on similar facilities designed by our architects and
over-runs and ultimately, the better off you are when
case basis. For each building or remodeling situation,
or done at other organizations. We prefer to take the best
it comes to managing the overall budget and cost
they do a thorough cost study and analysis and see
of the best,” says Stoughton.
containment for the project.”
SSM chooses their efficiencies focus on a case-by-
how much energy they are going to save.
SSM Health Care of Wisconsin has fully integrated medical health records and all the latest digital imaging.
ing at this point with the way the market is. “Archi-
They believe in building the proper backbone for superior
tects and builders and bigger contractors are pro-
option, but in this case they have determined that it
data and telephone connections. “It’s all internet based,”
moting partnering because they make their highest
makes sense fiscally as well as environmentally.
says Stoughton. “Everything is pretty much cutting edge
profits and best margins on those types of projects,”
when it comes to the electronic stuff.”
he says. “When everybody is on a controlled budget
Building for Best Practice
building the projects.” by T.M. Simmons
Stoughton doesn’t go for design assist or partner-
is going to be geo-thermal. That’s not typically an
A small 18-bed hospital in Edgerton, for instance,
ing in flexibilities as we’re planning, designing and
INDUSTRY PARTNERS
with a guaranteed maximum price, the end result
“Everybody’s got buzz words for doing similar type
Building in a Buyers Market
research – evidence based or whatever you want to
“Each project has a little bit of uniqueness that deter-
call it. We look at a lot of things in our system. We do a
mines how I want to contract for it,” says Stoughton.
lot of research when we first design a hospital such as
“This market is a buyers market. I am, as the hospital’s
to four general contractors whom he knows does
going to other facilities and looking at best practices.
agent, the buyer. The longer you can keep it on the street
superior work. “We don’t exclusively use one general
always tends to bump up against that maximum price. There’s no substantial savings.”
Flad Architects www.flad.com
Stoughton prefers to work with a stable of two
HCE EXCHANGE MAGAZINE Real Issues : Real Solutions
21
05 | Children’s Hospital of Eastern Ontario
Children’s Hospital of Eastern Ontario
The Children’s Hospital of Eastern Ontario is never referred to by its full name. Everyone in the region knows what CHEO is; an institution in its own right, one of the few stand-alone pediatric hospitals in Canada. The 36 year-old hospital has 167 beds and the largest pediatric emergency room in the province with about 57,000 emergency room visits per year. CHEO is a full teaching hospital associated with the University of Ottawa. It serves Eastern Ontario, Western Quebec, Eastern Nunavut and parts of Northern Ontario.
Ho ow ca c n I ac a hi hiev e e hi ev high ghgh q al qu alit ity o ity ou utc com omes ess at th t e lo owe west st po osssi sible do d se se??
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Life is precious – take CARE.
provide them, when they are here, with access to internet to keep the contact with their friends,” Bilodeau says. Catering to their need for knowledge,
Answers for life.
the children’s portion of the CHEO website includes a virtual tour of the surgical suites, as well as stories and games to teach kids about the human body and hospital terms and procedures.
Human Resources Considerations
Siemens Healthcare
The management of human resources has also
An Old Strategic Plan with New Emphasis
undergone significant changes. “When I started in
In the four years that Bilodeau has been with the
including medical imaging and therapy, laboratory
hospitals thirty-three years ago,” says Bilodeau,
organization, he has focused on moving from a family
diagnostics and healthcare IT. Siemens provides so-
“the average age of a nurse was 24. Now, it’s
type management philosophy to more of a business
lutions across the entire care continuum—from pre-
almost 50. We have an aging workforce. We have
model approach. “CHEO wanted to be everything to
vention and early diagnosis, to therapy and ongoing
shortages in physicians, in respiratory therapists,
everybody,” he says. “Now we’ve established priorities
care. At Siemens, our mission is find answers to the
“Like everybody else, we face the changing land-
and in several other professions. One of our main
and we’re trying to involve all levels of leaders, both
toughest questions facing the healthcare industry.
scape of our own patients,” says Michel Bilodeau,
challenges is in the recruitment and retention of
physicians and non-physicians, in the identification of
President and Chief Executive Officer of CHEO.
specialists.”
those priorities.”
Today’s Patient
“They get all kinds of advice before they arrive here.
The size of CHEO’s catchments’ area makes
integrated portfolio of product and service solutions
They are focusing research activities, for instance,
We have a tradition of taking care of everything, but
competition with other regions for specialists
on areas where they can lead, or at least be among the
for the youth—certainly the adolescents—they want
difficult. Population is denser elsewhere, which
best. Genetics is one example. The hospital already has
to take care of themselves and they arrive here with
means salaries are higher and volume of activity
the provincial newborn screening program and is the
lots of preparation.”
is greater. “There is more potential for research in
site for the Ontario perinatal surveillance system (now
other regions, so we have positions that we’ve been
Born Ontario). That’s an area where they are already
used for communication and providing patients with
unable to fill for several years,” says Bilodeau.
more advanced, so putting extra emphasis on this area
access to those forums is important, as well. “We
“That’s obviously creating difficulties.”
is a sure way to become a leader in the field.
Forums such as Twitter and Facebook are being
Siemens Healthcare; Answers for life—is a fully
“CHEO wanted to be everything to everybody.” HCE EXCHANGE MAGAZINE
Real Issues : Real Solutions
23
06 | Kingston General Hospital
Another shift is in rethinking CHEO’s regional role. Traditionally, all services have been provided within the hospital’s own four walls. “We started, two years ago, to discuss and negotiate with our colleagues in other hospitals throughout the region to try to support the development of children and youth services in the various sub-regions of eastern Ontario,” says Bilodeau. “A first successful project has been in emergency where we have trained the staff and physicians in all the hospitals in our region in several protocols and clinical pathways.” Rather than having children transported long distances because the individual hospitals don’t have the expertise, CHEO has worked with training the staff of each emergency room so that patients can be treated on location. “They have a direct link. They can contact our physicians by phone if they have problem. We have also established computerized linkages to allow them, for example, to have calculations of the exact dosage of medication that they need.”
Children and Youth are the Future “Although they don’t consume as many health care dollars as the elderly, the fact that we focus every-
Kingston General Hospital
thing on the aging population is problematic,” says Bilodeau. “Right now it seems that Ontario is moving toward rationing healthcare because we don’t get enough funding. Services to children are threatened because the volume is small in comparison to adults. When you look at things from a global perspective, 100,000 adults have a specific problem and only 500 children, so some services may be at risk.”
With constant advancements in technology and increased focus on patient and family centered care, many hospitals are finding that their facilities need upgrades to meet these changes and new demands. But knowing where to begin addressing these needs and how to adapt new technology to existing facilities can be challenging.
“Problems that are not resolved during childhood will become serious health problems in adulthood. My main concern is about our capacity to continue to develop services for children and youth. I don’t know how it’s going to evolve over the next couple years, but it’s going to be a concern.” by T.M. Simmons
Real Issues : Real Solutions
Ted Darby, vice president of planning and facilities for Kingston General Hospital in Ontario, has been entrenched in major redevelopment and renovation to the facility. Darby is responsible for facility planning, construction, plant operations and maintenance, safety and security, environmental services and food services. KGH is in the midst of a $196 million dollar redevelopment project that features seven components. To expand services and add patient rooms, KGH has built two additional floors on top of one tower and three additional floors on another building. The completed project will create 170,000 square feet of new space and renovate another 143,000 square feet.
ValuMetrix® Services ValuMetrix® Services is a consulting organization that is a part of Ortho Clinical Diagnostics, a Johnson & Johnson company. We focus on transforming operational performance in hospitals and other healthcare organizations. Our approach is interactive. We provide hands-on experience and a proprietary software toolset to lead your project team to develop solutions that optimize your processes. By training and mentoring your staff we equip your organization with the information and skills to effect and maintain improvements for longterm success.
Darby said he has noticed a trend toward increased
new floor includes a 25-bed pediatric inpatient unit
space, but not necessarily increased beds. “The
with all private rooms, six critical care beds and
trends are for more intensive care, more technol-
increased rehabilitation space, while the floor below
ogy and more space per patient room, but not larger
has beds for medicine and oncology patients, with
facilities because we are seeing a reduction in the
two nursing stations for each patient population and a
number of beds,” he said. “We see improved lengths
family lounge area. The unit also features six positive
of stay and care delivered in other settings such
pressure rooms for patients with compromised im-
as the home. But we need to upgrade our facilities
mune systems.
because we can’t deliver the care expected today in
Another component of the project is the first
facilities that are more than about 30 years old.”
phase of an expansion of the intensive care unit, which
With some of KGH’s facilities nearing a century old,
features critical care bays with articulating boom
the hospital needed to expand but also work on
arms, ceiling mounted patient lifts and three negative-
redeveloping existing space. “The new areas are
pressure rooms. The expanded ICU will also provide
bright, spacious and modern even though the design
a family-friendly environment with a lounge area and
was sometimes constrained by the existing build-
quiet consultation rooms. Once the entire ICU expan-
ings,” Darby said.
sion is complete, KGH will increase its capacity from
Although it had to work within existing facilities for much of the expansion and renovation, KGH
21 to 33 critical care beds. Other parts of the redevelopment project include
incorporated new technology and provided more
upgrades to central processing services (the area
comfortable spaces for patients and families. One
where surgical and treatment instruments and equipment are sterilized), enhanced adult and child mental health facilities, a new and expanded dialysis unit, and expanded cancer treatment capacity. Making the projects happen Obtaining government investment for major building projects is the first challenge, Darby said. Once the money is in hand, a facility must look at how to
There’s a science to optimizing performance
achieve good design for the best value for money in an environment where regulations, codes, standards and best practices are constantly changing. Darby said the key to success is finding the right people, with the proper expertise and maintaining a strong relationship with the consulting team, contractors and regulatory authorities.
OR used Lean to achieve
Hospital Emergency
Community Hospital
$578,000 in annual savings,
Department cut patient
used Lean to trim
increased caseload capacity by 17%
turnaround time by 29%,
saved $1.25 million in
lab turnaround time by 42%, achieved
without adding staff*
avoided construction costs*
$499,200 in annual labor savings*
“This is not a place to learn on the job,” Darby said. “You want to have a design team that thoroughly
understands hospitals and the needs of hospitals, particularly when you’re building inside, on top of and around a functioning tertiary care hospital. You want your mechanical and electrical contractors to really understand how hospitals work.” Environmentally friendly design and flexibility are also components of modern design. “We are conscious of green initiatives and standards and are constantly looking at ways to incorporate technologies that enable us to save energy and reduce our carbon footprint,” he said. By Patricia Chaney
Learn how we can help you. Visit ValuMetrixServices.com or call 1-908-704-3821 *Documented case studies on file. These are client specific results, individual results may vary. ValuMetrix® Services is a fee for service consultancy . © Ortho-Clinical Diagnostics, Inc. 2010 OC10659
HCE EXCHANGE MAGAZINE
27
07 |Fauquier Health Works with Community to Provide Care, Inspire Trust
Fauquier Health Works with Community to Provide Care, Inspire Trust
In the American healthcare market, many independent physician practices are finding it harder to survive; some consider mergers with hospitals or health systems so that they can continue providing care. Fauquier Health in Warrenton, Virginia, provides quality care in its facilities, and also supports local physicians to keep vital services in the community. “We work to fulfill our mission in the community of providing quality, patient-focused healthcare and tangible community benefit,” said Rodger Baker, president and chief executive officer. “Despite our growth, we remain a small, independent organization.”
Branching out to new markets Fauquier Health is the larger holding company for several smaller organizations. Located in a suburb of the Washington, DC, metropolitan area, corporations under the health system umbrella include Fauquier Hospital and Fauquier Senior Living, the system’s long-term care division. The Fauquier Health Rehabilitation and Nursing Center, a 115-bed skilled and intermediate nursing care center, is a cornerstone of that division. The health system has recently expanded its senior living services with a $20 million assisted living facility. The Villa at Suffield Meadows is a 72-bed facility that opened in September of 2010. Most of the residents pay for care through private savings or longterm care insurance. “The assisted living facility provides a level of care that is a little less intense than that provided in the nursing home,” Baker said. “It’s a strong need in our
Baker said. “In our industry, many people are getting out of a residency or fellowship and want to focus on practicing medicine and not be concerned about the business of a practice.” The model provides infrastructure, office space and office help, including marketing, billing and scheduling. Baker said the hospital is evaluating salary options, namely an annual base salary with incentives for productivity. Most of the physicians will have contracts of about three years and come from various specialties. By being part of the larger health system and having more resources, the physician organization is able to bring in specialists that smaller practices may find risky. “This venture is allowing us to bring in specialties that previously weren’t offered in our community, such as an endocrinologist and an infectious disease specialist,” Baker said. Fauquier Health has also provided assistance to a struggling primary care office. “From time to time
community, and we expect it to be full within a year.”
there may be physician practices that may need the
Supporting joint ventures and local physicians
said. He explained that a three-physician practice
About three years ago, Fauquier Health founded Fauquier Health Physician Services, a group of physician offices operated by doctors employed by the health system. “We have had relationships with physicians for many years, but they have not been employed by us,”
Real Issues : Real Solutions
help of an outside organization to survive,” Baker in the county lost a primary care provider and was facing higher overhead. The remaining physicians approached the health system suggesting a buyout, and asked for help recruiting a third physician. “It is important to keep primary care services in the community,” Baker said. “Without our help, those physicians might have to leave the area.”
In addition to supporting local practices, the health
“We position ourselves to have a certain level of trust,
system works to meet the requests of its community
sharing information about where we are and our
physicians. Fauquier has a joint venture with Prince
future plans, engaging employees, community leaders
William Hospital to provide radiation oncology in an
and other constituents about where we should go,” he
area between the two facilities. The Cancer Center at
said. “We want to truly reflect the community, not just
Lake Manassas sees about 45 patients per day.
the management team.”
“We were able to spread the cost between two
The health system also embraces a patient-
organizations and leverage two markets, allowing us
focused care model, providing boutique services and
to put together an entity that was more cost effective
individualized care.
and served a broader region than either of us could by going it alone,” Baker said. Another joint venture is with Valley Health System,
“We are trying to differentiate ourselves in a competitive market,” Baker said. “We can’t always compete in terms of services because we don’t
located about 45 miles from Warrenton, to provide
have the size or volume of some surrounding health
medical equipment for home use. This partnership
systems. So we focus on providing personalized care
came about after physicians in the community asked
that larger organizations may not be able to offer.”
the health system to provide these services. “We didn’t have the expertise in this area, so we
By Patricia Chaney
looked for a partner that had been in the business for some time,” Baker said. The services are managed by Valley Health, but there is a storefront in Warrenton.
Maintaining a philosophy of care With this growth and expansion into new areas, Baker said the expertise of the management team has been critical to success. The leadership works to maintain transparency and inspire trust in the community.
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08 | Flagstaff Medical Center
Bridging the gap between medical staff and the board of directors To adequately support these endeavors and others,
ations and changes,” he said. “We’ve seen continued improvement and have begun working on more quality measures.” In addition to working with the medical staff, Dr. Lewis is also accountable to the Board of Direc-
support from the medical staff is critical. As chief
tors. “Another factor in being successful in my role
medical officer, Dr. Lewis says the key to success is
is learning how to be a meaningful member of an
“knowing how to communicate.”
administrative team,” he said.
“You have to understand the nature of the relationship between medical staff members as individuals and as part of an organization,” he said. “In my role I work closely with the medical staff, helping the medical staff organization and individual members work on quality measures to improve the level of care we provide on continuous basis.”
He reports regularly to the board on all quality measures, clinical staff issues, and patient satisfaction with the facility’s clinical care, while being the representative from the senior management team. Bringing all these aspects together into one role is difficult, and Dr. Lewis continues to stress communication as key. One test of this role recently has
The hospital has been working hard to reduce
been the implementation of computerized physician
surgical site infection rates. “Our current rates are all within expected norms, but we decided that we wished to improve beyond
order entry (CPOE) at Flagstaff. Dr. Lewis was at the forefront of managing physician concerns with this change: Why should I do this? How does this impact
that, and we initiated some extensive process evalu-
my productivity? How does it improve patient care? “In this situation, the first step is understanding that the project can go no faster than the medical staff
Flagstaff Medical Center
is willing to accept it,” he said. “We created interdisciplinary leadership of both administration and medical staff. Over about three or four months, teams were more in tune with each other’s needs – not necessari-
With most physicians being independently employed, communication between the medical staff and administrative staff is essential to the functioning of any facility. Steven Lewis, MD, chief medical officer and senior vice president of Flagstaff Medical Center, has spent the past three years working to manage the interests of medical staff in a hospital environment.
ly in agreement, but more understanding. For the next three to five months they developed joint plans.” Dr. Lewis said the stakeholders have reached a point where they recognize each other’s needs and differences and agree to find a way to implement CPOE in the best way possible. “That’s been about a seven-month evolution.”
“The chief medical officer is a broad spectrum role focused on clinical care, primarily on the physicians’ contribution to that care, but also working closely with nursing leadership and helping to ensure the community needs are met on clinical basis as best we can,” Dr. Lewis said.
Challenges to leading medical staff One of the challenges Dr. Lewis faces, that is com-
Flagstaff is a 272-bed, tertiary care facility that serves a large geographic area, including many rural communities in Arizona, and a diverse population, including many Native Americans. The hospital has a full spectrum of support services, with a Level 1 Trauma Center certified by the state of Arizona, a 30-bed intensive care unit, a pediatric intensive care unit and a robotic surgical program. Dr. Lewis estimated that Flagstaff will see about 45,000 patients in the emergency room this year. The hospital’s bariatric surgery is designated as a Center of Excellence. Flagstaff is working on initiatives to improve quality and provide more services to patients in its community. In March 2010, the hospital opened a technologically advanced cardiac catheterization lab, providing minimally invasive procedures and advanced imaging.
mon to many hospitals, is employed physicians versus independent physicians. Flagstaff has a small number of employed physicians, including all hospitalists, two cardiologists and some other specialists to fill community needs. Dr. Lewis said the hospital has been transparent about why it has used the “employment vehicle” and openly discusses plans for additional employed physicians with the medical staff. “We address why we choose to employ some phy-
making some progress. Our hospitalist function has become a part of how we do things here, and the medical staff has become comfortable with that arrangement.” Dr. Lewis is pleased overall with the success Flagstaff has had in bringing together the various interests within the health system. “I think in this environment the working relationship between the hospital and medical staff is critical and is going to become more critical. I believe it’s safe to say this organization and the medical staff have made a lot of ground in working together, to plan together, to lay ground together,” he said. “That doesn’t mean it’s smooth or all issues are agreed upon by both parties, but at least the foundation exists.” By Patricia Chaney
sicians in a regular, open fashion,” he said. “We are
HCE EXCHANGE MAGAZINE Real Issues : Real Solutions
31
09 | George Washington University Medical Faculty Associates *: SK\V ),1B SGI *: SK\VB B),1B SGI $0 *: SK\VB B),1 *: SGI SGI $0 $0 $0
Streamlining care by going paperless Part of streamlining processes has come from a large investment in technology. The group has implemented an electronic health record in all settings except psychiatry and cosmetic surgery. So far, Badger says going paperless has yielded a significant return on investment not just in overhead costs for staff and paper records storage, but also in streamlined workflows and patient care. “We have connectivity with our lab vendors, as well
time,” Badger said. “When you’re dealing with high volumes of paper, you run into problems. Technology allows you to manage it dramatically better.” Another investment that has saved time and money on support costs has been a new palm scanner kiosk at check-in. This allows patients to update their own information and bypass lines at the registration desk. “We’ve found that the quality of data is better when people take ownership of their own information,” Badger said. ”The quality of registration goes down when you have long lines.” This helps improve the quality of
as with The George Washington University Hospital, so
check-in and reduce staff needed at the desk.
we get X-ray reports, labs and other data to integrate
Putting the savings to work
with the health record,” Badger said. “A physician now sees a complete list of allergies, medications, all labs and diagnostic data in one repository.” “This has transformed our practice from being reactionary to proactive. For example, if there’s a drug recall, we send a notice to our physicians with patients under active medications so that the physicians can reach out to them, rather than patients hearing about it on the news.” “When a lab comes in, we no longer have to have support staff pull the medical record, route it to the physician manually, and hope they file it correctly every
With revenue rising faster than overhead costs, The GW Medical Faculty Associates has been able to make improvements to patient care areas and expand its services. Those dollars are redeployed to grow and expand the practice; overhead has not grown nearly as dramatically. Badger said the practice has also been able to use the increased revenue to incentivize physicians and remain a competitive employer. One recent investment in the facility has been the opening of a new infusion area in the Katzen Cancer Center which was built in space which used to hold the old records room. The infusion space was created with patient comfort at the forefront. Badger said the facility is a “spa-like” environment. When patients check in,
George Washington University Medical Faculty Associates
there are two water features, music playing and televi-
“We have all the ingredients in place, but still need
sions on the wall. The practice also provides laptops for
champions to drive quality initiatives and clinical
patients receiving chemotherapy to browse the Internet
research,” Badger said. “I think this is an area of
or watch movies.
opportunity for us – to approach research in a more
“The cancer center is a friendlier environment and more soothing than the old environment,” Badger said.
The George Washington University Medical Faculty Associates is a large academic multi-specialty group practice with more than 550 physicians. The group trains more than 400 residents and fellows and more than 700 medical students. The practice serves an average of 4600 outpatients every day. Unlike a hospital, The GW Medical Faculty Associates is a high-volume, low-margin environment, and efficiency and process are keys to success.
unified way across the organization.” Badger champions electronic health records and
“All the heated-chemotherapy chairs are designed
technology as ways to improve patient care as well
for comfort and we have laptops with Wifi-access and
as a group’s bottom-line revenue. He notes that ap-
a library of movie CDs we offer patients during their
proaching change as a team has helped the imple-
chemo visits We have really given the cancer program
mentation. “We have worked at getting everybody to
here a facelift.”
see and understand our direction, embrace change
Looking forward The GW Medical Faculty Associates is continuing to
– recognizing it’s going to be a significant investment and an asset,” he said. “All of our investments so far have yielded high returns.”
look forward at ways to best utilize technology in “Our values are hard work, tenacity and attention to detail,” said CEO Stephen Badger. “We try to do things right the first time. If we have problems or issues, we try to identify root cause and correct processes. “
patient care and research. As an academic facility,
By Patricia Chaney
the practice also has a strong focus on research, and Badger said that is one area where the technology is currently underutilized.
HCE EXCHANGE MAGAZINE Real Issues : Real Solutions
33
10 | Huron Perth Healthcare Alliance
Expanding facilities Stratford General Hospital is the largest facility, serving as a secondary referral site for Perth and Huron counties through the provision of specialist and intensive care. The Clinton, St. Marys and Seaforth sites provide inpatient care, clinics and other services to their communities. Stratford recently completed a $65 million capital redevelopment project to renovate existing space and add a 75,000 square foot wing to the hospital. The renovated space was occupied in 2009 with a new intensive care unit, pediatric unit, mental health unit and three education meeting rooms. The second phase was completed in August 2010, adding a north wing that featured a new central processing department, emergency department and imaging department on the first floor; the second floor included a
new surgical services department with day surgery, an endoscopy suite and five operating rooms. “One of the great things about building a new building is being able to adopt a lot of new technology,” said Anne Campbell, Director of Corporate Planning. “Even in the renovated space we were able to incorporate new technology such as Conmed arms suspended from the ceiling that are able to hold our vital equipment. This arrangement places equipment at a convenient height and location , provides more mobility in positioning patients and improves safety. We are thrilled with this great addition in technology.” Another technology which the hospital incorporated in the redevelopment project has been a pneumatic tube system for transferring lab specimen, medications, and supplies between units. Campbell said this system saves staff time and enhances patient care. The Stratford Hospital also installed an automated carousel system in the new Central Processing Department that allows staff to electronically select all elements
Huron Perth Healthcare Alliance
required which then wrapped and sterilized. Campbell says this system also saves time and improves accuracy and efficiency. The building project has allowed much of this new
Huron Perth Healthcare Alliance in Ontario was established in 2003, bringing together four community hospitals into one organization, with one board of directors and one management structure. The four hospital corporations include Clinton Public Hospital, St. Marys Memorial Hospital, Seaforth Community Hospital, and Stratford General Hospital. “The Alliance was viewed as an opportunity to improve patient care in the Huron Perth region by viewing it as a system rather than individual sites,” said Chief Financial Officer and Vice President of Operations Ken Haworth. “Each individual organization was trying to move forward its own perspective and the Alliance allows us to maximize resources, maintain one budget, and have a shared human resources pool from which all sites can pull.” Haworth has been in his role since the birth of the Alliance. He said the Alliance has had a balanced budget for six years. The agreement to come together has shown great improvement in services, but the initial integration had its challenges.“The first four years were the most challenging,” Haworth said. “We had to integrate into one information structure and one management structure. The end result has been almost like a regional information system across counties. This structure allows for standardization of practice across the corporation.” Haworth also said the leadership of each hospital corporation and community members was critical to the success of the voluntary integration. “You need communities that agree to participate in this manner, to think from a system perspective rather than a local perspective,” he said. “You need that kind of person sitting on your board or else it becomes divisive.”
technology to be implemented. “We want to follow best practice in providing services with a new building,” Campbell said. “We have standards we follow to provide care, and we get input from our specialists. Once we know what the new technologies are, we can build accordingly.” In addition to planning the redevelopment project
Improving efficiency With the successful voluntary integration and redevelopment of the Stratford site complete,, the orga-
to incorporate state of the art technology, the Alliance
nization is now looking toward optimization. Haworth
needed to find a way to fund the technological additions.
said the Alliance is rolling out a process optimization
Haworth pointed out there was a substantial fundrais-
initiative, piloting the program first in the Laboratory.
ing aspect to the redevelopment project. The Ministry of
So far the program has shown significant improve-
Health and Long Term Care provided 90 percent of the
ment in turnaround time and some financial savings.
funding for the expansion’s construction, the Alliance
“This initiative is not just a process transforma-
was responsible to fundraise for the other 10 percent
tion but a cultural transformation,” Haworth said. “We
for construction and 100 percent of the new equipment..
feel process optimization impacts our four priorities:
“We were trying to raise about $20 million,”
quality, access, fiscal health and workplace health. .
Haworth said. “The Stratford Hospital Foundation took
We can reduce errors, improve turnaround times and
the lead and despite our local economy being hit hard
enhance our workplace environment. We are already
recently, the Foundation met and exceeded its goal.
seeing a return on investment.”
That speaks volumes towards the generosity and support of the people of Stratford and surrounding areas.”
By Patricia Chaney
HCE EXCHANGE MAGAZINE
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11 |
Information Management & Information Technology at
Interior Health Authority
Information Management & Information Technology at Interior Health Authority Malcolm Griffin is the Chief Information Officer for the Information Management & Information Technology (IMIT) Department of Interior Health Authority, one of six health authorities in British Columbia. It serves 265,000 square kilometers and a population of about 750,000. As a predominantly rural health authority–the largest city has a population of 175,000–the organization is wired for leading technology. It has garnered several awards regarding its information management and technology practices in recent years.
Turning Physicians from Skeptics to Supporters Most of our physicians were very skeptical when we started,” says Griffin. “But as we got through it [the initial pilot program] they became our biggest supporters. Our physicians now say they can’t imagine living without the system.” In 2005, Interior Health began implementing a vision that would eventually mark them as leaders in integrating information technology into healthcare. Several initiatives were introduced, the major ones falling under the headings of an electronic health record, a tele-health program and patient safety systems. “With the safe hospital project, our goal was to make sure we had all the technology support and business process support necessary to allow us to insure we were giving the safest, most effective
the needs of that patient better,” Griffin says. “From a holistic perspective, we are able to treat in a more effective manner, not only from a facility perspective but from a community perspective.” All of this was done on an older information system platform, yet worked so well they were able to convince stakeholders to build a business case to do a wholesale upgrade of the platform to a more userfriendly application. “We took about 500 of the clinicians and put them into 30 working groups and spent a year working on standards for nomenclature and process optimization,” says Griffin. “When we finished a year ago in September, we began building the process and the nomenclature in the new information system. It will be rolled out in six states, starting with one of fairly significant size with two cities and a number of rural communities. We’ll be rolling that out over the course
care possible,” says Griffin. “Phlebotomist come
of next 18 months.”
to the bedside and scan the patient and then also
Partners in Technology
scan the vial making sure they have the right match. Bar coded drugs and identification wrist bands are scanned by nursing staff at the bedside to make sure we have the right drug, dose, route and time for the right patient.” They began working with physician order entry
The primary partner in the technology platform upgrade is Medical Information Technology, Inc., more commonly known as Meditech. “The Meditech version is much more user friendly from a clinician perspective,” says Griffin.
and began linking back to make sure the primary care physicians received the results via an electronic interface. “We also wanted to have a medical summary of the information that is captured in the primary care clinics so that when a patient presented in an emergency, the physician would be able to access a summary of that patient and make sure they understood
HCE EXCHANGE MAGAZINE Real Issues : Real Solutions
37
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“We’re seeing a new trend—which I think is a good one.”
They use Polycom equipment extensively in the tele-
place,” says Griffin. “It’s very seldom now that we expect
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health program. Interior Health Authority is involved
people to have separate work and home devices. As we
in about 10,000 tele-health consults per year in about
see that evolve, we experience challenges regarding
52 different clinical areas. In residential care settings,
security. We have to be much more diligent in our care
they work with Goldcare, the healthcare division of
and how we protect information and secure information.
Campana Systems, Inc.
That’s a big challenge moving forward.”
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“I really believe that the CIO role has changed from
with, and access information. I believe that as we move
a technical enabler—we still are responsible for
into more of a community model of care where your
enabling process through technology—but it’s really
primary care provider who is going to carry you through
becoming more of a a business partner,” says Griffin.
whatever needs you have as a patient, may or may not be
“The job now is more about understanding the core
a physician. It is going to become a different model than
business of healthcare and sitting down with the folks
we see today.”
www.polycom.com 1-800-POLYCOM.
IBM and EMC are also large partners in terms of office and information technology.
From Technical Enabler to Business Partner
Griffin also sees this trend in technology changing the role of the patient in healthcare. “I think that what we’re going to see is the expectation that the patient is going to become a true partner in care,” he says. “They are going to expect to have the ability to provide, interact
who are actually responsible for delivering healthcare in an operational setting. It is to really understand
by T.M. Simmons
what their needs are and to align our investments and our strategy with that of the organization.”
The Patient Also as Partner “We’re seeing a new trend—which I think is a good one—which is to bring personal devices into the workHCE EXCHANGE MAGAZINE
39
12 | Mountain View Regional Hospital
Thin on Administration, Heavy on Quality “The physicians and I pretty much work hand-in-hand to get things done, both strategically and operationally,” says Burris. “It’s not death by committee around here. If you need to get something done, this ship is easily turned.” The physicians who built the hospital were focused on creating a healthcare facility where they could directly affect the clinical outcomes without a lot of bureaucracy. Burris says the owner-operator mentality means that folks are intrinsically invested. “You can’t just ask someone to care and to start caring right and we have state of the art equipment. What sets us
The Three-Legged Stool of Healthcare
apart and gives us our competitive advantage is our
The hospital took off so successfully that Mountain
people. I think that’s an advantage that you find in at
View began bumping up against capacity in its first
least this physician-owned hospital, the direct connec-
year of operation. A $2.5 million, 14-room expansion
tion between the physician and the staff which really
was begun and completed in 2010. Healthcare reform
enhances that ownership mentality and drives people
changed the landscape, however. The hospital is cur-
to have that component of caring about what happens
rently unable to license those beds for inpatient use.
not just to the organization, but to the patients and
“Of course there are other ways we can utilize these
families that we serve.”
rooms,” says Burris, “but ideally, the purpose of build-
now,” he says. “Of course, we have a beautiful facility
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We have hit capacity on our census numerous times
Mountain View Regional Hospital
and it’s very disheartening that we can not serve the
geons and the hospital will continue to accommodate
needs of our community because of legislation that
as many patients as possible. The hoped-for inpatient
prohibits us from opening these beds.”
rooms can be utilized as observation rooms for day-
“I’ve always viewed healthcare as a three-legged stool: affordable, accessible, and quality driven,” says
The Mountain View Regional Hospital opened in Casper, Wyoming in June of 2008. It is a 23-bed, specialty surgery hospital that is 50% physician owned. Its corporate partner is National Surgical Hospitals based in Chicago, Illinois. It began as a hospital specializing in neurosurgery, but in the short time it has been in operation the organization has also established itself as a center for orthopedic surgery, general surgery, plastic surgery, bariatric surgery, nose and throat surgery, and pain management. The hospital also has an emergency room and a total of about 150 employees. “The physician ownership model is one that is a lot more operationally efficient,” says Don Burris, CEO. “Patient satisfaction is higher due to physician involvement at the governing level. As well, clinical outcomes are better and infection rates are lower. From an operational paradigm, physician-owned hospitals have a lot of benefits over traditional hospitals.”
surgery patients, for instance. “There is a lot of outpatient or same day surgeries
Burris. “What’s been done in terms of healthcare
that we can accommodate in that space, so we do still
reform, specific to our facility, is that access has been
have the ability to increase our volume and accommo-
addressed in terms of everyone having insurance. Si-
date the community in that way,” Burris says.
multaneously we’ve limited capacity in our facilities— specifically physician-owned facilities—that demonstrate there is a need in the community because we’re hitting capacity.” “I think the ultimate effect is that you are going to
The Physician in the Healthcare Equation “It would behoove the folks looking at healthcare optimization, instead of focusing on some of the things
have overcrowding in other facilities. Folks are going
they view as prohibitive to physician-owned hospitals
to be just running through the system as fast as they
or physician involvement in hospitals, to truly take a
can and, ultimately, the quality leg of that stool is go-
look at the operational side, to look at the numbers
ing to be impacted.”
and facts versus the anecdotal information. I think
Still Growing, None the Less
that’s the thing that’s left healthcare, the realization that the physician is at the center of it. It is very
Regardless of legislative changes, Burris still sees
important that we reintroduce the physician into the
growth in the future of Mountain View. Three of the
healthcare equation.”
four operating rooms are frequently running at capacity. There is continued recruitment of additional sur-
by T.M. Simmons
HCE EXCHANGE MAGAZINE Real Issues : Real Solutions
41
13 | Parkview Hospital
Because it’s the Right Thing to Do A few years ago, the little hospital was one of six in the state to win a quality improvement award from the governor of Texas. Patient safety is at the top of Parkview’s agenda. Fagan-Cook implemented a medication dispensing system from MDG Medical for drugs shortly after she started working with the organization. “I’m a registered nurse; have been one for 34 years,” she says. “I realized we were having medication errors
made head of the steering committee.” The Parkview Board of Trustees is also a longterm group. “Some of them have been trustees for more than twenty years. They are pretty involved in what is going on which helps a lot. There’s nothing worse than making a big presentation and them saying, ‘Nope, don’t want to do this.’ It kind of takes
The Future of a Rural Hospital
table, Parkview began working toward an electronic medical record. It is something they’ve had in mind for the last four to five years. Last year, a couple of board members went to a trustee training meeting and they came home with information from Prognosis Health Information Systems out of Houston, Texas. “We looked at it and we agreed with them,” says FaganCook. “We have been very pleased.” One obstacle has been that a lot of Parkview’s equipment is not necessarily computer friendly. “They have to have interfaces and things you don’t know about until you get into the business of getting an
Parkview is a level four trauma center supported by county taxes. They also have a home health agency, an ambulance service and a total of three physicians and one dentist. Seventy-seven full-time employees work for the organization.
that this is a project we need to take on, someone is
went to an electronic dispensing system for drugs.
Well before the stimulus incentives were on the
“We have a true team here,” says Ann Fagan-Cook, CEO and Administrator of Parkview. “I have employees who have been here for 29 and 30 years. They have dedicated their whole work lives to this hospital.” Of Parkview’s three physicians, two have been there for more than 35 years. “That’s pretty extraordinary for rural hospitals anywhere,” Fagan-Cook says. “The average length of time for an administrator is about three years and I’ve been here almost eight. I’m only the third administrator they’ve had since 1963.”
not we need to do it,” she says. “If there is consensus
the wind out of your sails,” says Fagan-Cook.
0.05%.”
Last year when a bus wrecked in icy conditions on an interstate in the Texas panhandle, Parkview Hospital received 29 patients all at once. That’s a significant load for a 16-bed hospital that serves a 908 square mile service area that averages less than seven people per square mile. Within 20 minutes, the entire staff of Parkview was assembled. Dietary staff who heard on the police scanner that accident victims were coming in arrived at the hospital to fix breakfast for everyone.
opinion about why we need to do this and whether or
that I thought were absolutely outrageous, so we Our error rate was about 4 to 5% and we cut that to
Parkview Hospital
“Then we have a meeting and get everybody’s general
electronic record,” she says. “Prognosis has worked very closely with us.” The outpatient portion was up and running first and the inpatient portion soon followed. A nearby hospital also picked Prognosis, so the two have done a lot of work together to transition to the electronic record.
Making Changes in a Small Hospital Setting “The first thing you have to do is get buy-in and commitment from the staff,” says Fagan-Cook. “If you don’t include them and convince them on the front end, it will never happen on the back end.” When introducing initiatives, she starts by distributing all the pertinent details to everyone.
Parkview relies on its designation as a critical access hospital to keep the doors open. “We’re not branching out right now,” says. Fagan-Cook. “We don’t have any surgeons here; we don’t do any surgery, and we don’t deliver babies except in emergencies.” Fagan-Cook says one of the keys to operating in such a rural area is to carefully decide whether or not the programs you consider putting into place are sustainable. “We’re here to provide services for the county,” she says. We really are a service oriented organization and if you don’t follow through with what you say you are going to do, the people stop coming to your hospital. We always make it our goal to do what we say we are going to do.” by T.M. Simmons
INDUSTRY PARTNERS MDG Medical, Inc. www.mdgmedical.com
“We always make it our goal to do what we say we are going to do.” HCE EXCHANGE MAGAZINE
Real Issues : Real Solutions
43
14 | Piedmont Fayette Hospital
said. “So that is why we opened the wellness center,
at ways to partner and do business with our doctors,
which we were able to do through philanthropic sup-
whether through management models or employment.”
port. It has been rewarding to see how patients and the community are responding.”
Improving efficiency With the fast growth Piedmont Fayette has experienced, the hospital is now working to improve on efficiency.
of the hospital. “Probably the best example we have right now is all of our cardiologists at the Piedmont Heart Institute are
“Lean” and trying to look at ways to eliminate waste in
alignment as far as supplies and quality initiatives. It
our processes,” Burnett said. “We have done this with
was tough to get to that point though, and it took a lot of
emergency department patient flow, admission flow
negotiation and cooperation.” He also cautions that what works for one specialty
these areas with staff participation in the
may not necessarily apply to another. The hospital
lean projects.”
always works to stay transparent, looking at these decisions with physicians and working on things as a
Medassets to evaluate supply chain management,
team. Burnett also said that the hospital has seen more
which is also seeing improvement.
requests for employment from physicians, developing
Healthcare reform is also a constant concern when evaluating efficiency. “We are focused on what healthcare reform means,” Burnett said. “One initiative is finding ways we can breakeven with Medicare
those models will be an ongoing opportunity and challenge for the hospital. By Patricia Chaney
cost coverage, which we currently lose on. That’s part of becoming more efficient. We try to address what’s happening with reform, but not at the expense of our patients and employees.”
The hospital has been focused on meeting the needs of its rapidly growing community, adding multiple services, and is now moving toward improving efficiency.
reform. Employment models have worked in some areas
employed,” Burnett said. “We have seen some great
Burnett said the hospital has also teamed up with
Piedmont Fayette Hospital, located in Fayetteville, Georgia, has seen tremendous growth since its opening in 1997. For the past thirteen years, the hospital has grown from 100 beds to 143 and has filed with the state to get an additional 14 beds.
sician relationships, all within the scope of healthcare
“We have been focused over the past few years on
on the units, and we‘ve seen some great success in
Piedmont Fayette Hospital
This is a common challenge in many hospitals, and Piedmont Fayette is working through challenges in phy-
Another aspect to efficiency is technology. Piedmont Fayette has fully implemented CPOE and
INDUSTRY PARTNERS Earl Swensson Associates, Inc www.esarch.com
electronic charting. The hospital is evaluating how to “I believe growth can hide a lot of flaws,” said Michael Burnett, the hospital’s chief operating officer.“Our goal now is to improve upon operations and efficiencies.”
invest in a fully integrated system to be more connected with physicians and the organization. “We are looking at ways to integrate electronically with employed and non-employed physicians, primary
Going through rapid growth Piedmont Fayette Hospital is a not-for-profit community hospital and is part of a larger Piedmont Healthcare system of four hospitals. Since 1997, the hospital has added a cath lab and obstetrical services, as well as obtaining a daVinci robot. The hospital also began offering an interventional cardiac program. All of these services were previously not available in the community. Most recently, in 2010, the hospital opened a cancer center with the first linear accelerator in the
county. The cancer center was a major initiative for
care physicians and specialists, as well as with our
the hospital, and took a patient-centered approach
sister facilities,” Burnett said.
with a goal of treating the patient’s whole experience of-the-art care. The cancer center includes a well-
Changing the physician relationship
ness component that offers nutrition classes, cooking
In light of growth and healthcare reform, Piedmont
demonstrations, yoga, a library and support programs
Fayette is facing a changing environment with physi-
for the community.
cians and trying to find the best relationship.
in dealing with the disease, while still providing state-
“In the past, particularly in cancer care, we have
“We are team oriented within the system and hos-
always taken good care of our patients clinically, but
pital,” Burnett said. “Our initiatives are often physician
not always in terms of the whole experience, address-
led; each quality team has physician representation.
ing what they are going through with cancer,” Burnett
But with reimbursements being cut, we are looking
HCE EXCHANGE MAGAZINE Real Issues : Real Solutions
45
San Jacinto Methodist Hospital
15 | San Jacinto Methodist Hospital Wilson Architectural Group Wilson Architectural Group is proud to provide archi-
With economic changes in the healthcare market, hospital systems are focused more than ever on ways to improve quality and control costs. It’s important to invest in technology and patient services to stay competitive in the market, but in today’s reform-oriented climate, those investments must be evaluated against lower reimbursements and strict hospital budgets. San Jacinto Methodist Hospital located in Baytown, Texas, has been focusing on ways to ensure high-quality patient care and manage costs. Dan Newman, vice president of ancillary and support services and business practices officer, takes a practical, economical view of the facility’s needs, while still maintaining a focus on quality.Berney, Chief Operating Officer.
tectural and interior design services for San Jacinto Methodist Hospital. We extend our congratulations on their success and look forward to continuing our relationship for years to come.
Ensuring quality In addition to controlling costs, San Jacinto has always maintained high quality care for its patients, being ranked in the top 5 percent of hospitals nationally according to Health Grades. Newman sees this focus continuing to increase.
scan times,” Newman said. “No one else in our market has technology that advanced. We’ve also added a new linear accelerator for our patients receiving radiation therapy. “We are also in the middle of constructing a hybrid operating room, which will soon offer open heart surgery in our community, a first for our hospital and market. We also licensed additional beds for a new intermediate care unit.” The hospital has invested more than $2 million in renovating the radiology department to provide a better separation of inpatient and outpatient services to provide an improved experience for patients. As part of these upgrades, Newman also stresses the importance of the less glamorous capital investments that must be made to go accompany them. “We have to balance investments for the benefit of the patients with investments in infrastructure,” he said. “These might include renovations to the parking lot to ensure it accommodates patients as we expand services. Signage is another example, making sure people can easily get where they need to go.” As vice president of ancillary services, Newman is
Maintaining controls on cost is always a challenge,
responsible for services including radiology; physical,
and Newman recognizes the need to balance capital
speech and occupational therapy; laboratory services;
investments that provide improved patient care and
radiation therapy, as well as maintenance, house-
compete within the facility’s market, with comple-
keeping and dietary. San Jacinto, which is part of the
mentary investments in infrastructure, as well as with
larger The Methodist Hospital System, has recently
overhead costs such as salaries.
invested significant money in technology and creating
“We have always been focused on being good stewards of our resources and being conscious of
an improved patient experience. “Some of that technology includes a 128-slice CT scan, which reduces dosage to patients and lowers
controlling expenses, and that has become even more important for us and the industry in general,” he said.
“When we look at healthcare reform there will be increased focus on ensuring high quality care more than ever,” he said. “Payments will be based on ensuring quality, giving us more reasons and incentives to ensure we’re providing high quality care to our patients.” Newman says part of their keys to success in quality are diligently tracking errors or potential errors, structuring the leadership to support quality initiatives and helping clinicians reduce distractions and focus primarily on patient care. San Jacinto uses an electronic incident reporting system to log and track errors and near misses. Newman says the hospital also focuses on instances where no harm occurred but the potential for harm exists. An example would be early identification of failure to give medication to a patient. Even when no harm was caused, they evaluate the reasons behind the potential mistake and take action. Newman also credits the facility’s chief executive officer and leadership structure for making their quality efforts so successful. “Our CEO was previously our Chief Operating Officer and Chief Nursing Officer, providing our organization with a heightened sense of importance of providing quality care to patients,” he said. “Her philosophy drives the rest of the organization in ensuring that quality and safety take precedent over all else.”
focused on patient care. One change has been the implementation of a weight-based system for managing supplies. Supplies are in bins on weighted racks. When a supply is low, the system notifies the corporate office who then places the order for required supplies. This takes the clinician out of the ordering process, freeing up more time for patient care. San Jacinto consistently seeks ways to improve quality and manage resources and plans to see even more focus on these areas in the future. “There’s always some uncertainty with the future,” Newman said. “We’ve seen more of that with healthcare reform. What’s important is how you respond. Our focus on quality and best use of resources will continue.” By Patricia Chaney
Another aspect of leadership is the choice of a patient safety officer who has more than two decades of clinical experience within the organization and a physician as the Chief Quality Officer. Newman also says that other changes have helped improve quality by allowing clinicians to be more HCE EXCHANGE MAGAZINE
Real Issues : Real Solutions
47
University of Texas Health Science Center at San Antonio
|
16 | University of Texas Health Science Center at San Antonio
In 2006 while the project was bidding, inflation in the construction market was rampant. “We had to deal with rising costs and supply shortages,” says Lew.
Last year, the University of Texas Health Science Center opened the Medical Arts & Research Center (MARC), a 286,000 square foot building that stands eight stories high. The MARC is now the clinical home to 250 UT medical faculty that consolidates their main clinic with many of their smaller clinical locations which formerly were located throughout the city of San Antonio. The building also includes an ambulatory surgical center, a medical imaging suite, and two floors of medical school offices.
“It was pretty stressful during design to just keep the project in budget.” The eighth floor of the building in fact, was initially planned as a shell to help control costs. “It was entirely shelled on the recommendation of our project team,” says DeLeon. “We were carrying a price for the eighth floor throughout the course of the project and about half way through, it became evident that through good budget management by the team and leadership from the campus’ Office of New Construction, we were able
Richard DeLeon and Patrick Lew work for the UT System Office of Facilities Planning and Construction. DeLeon is one of six program managers for the System’s $4 billion in active construction projects around the state. Specifically, he oversees capital construction projects for one healthcare and three academic campuses in South Texas. As a Senior Project Manager, Lew oversees projects on the San Antonio campus.
to finish the entire floor.” “There were other examples of flexibility as well,” says Lew. “We started with a greenfield site and through efficient planning we actually only used about half of it. The facility was planned so that it could be expanded in the future.” “The building was designed to make it convenient
Building the MARC
for the patients,” says DeLeon. “Also, the exam rooms
“The UT System is a public entity,” says DeLeon,
were zoned in a manner to allow the different clinics
“so we are bound by not only federal and state laws,
to flex between each other depending on the demand
but we also have a board of regents that oversee our operations. It can be an interesting challenge delivering projects in such a dynamic industry, but fortunately we have very established processes that
an open qualifications basis. Firms are able to submit their qualifications in response to publicly advertised selection criteria. For the MARC, they selected FKP Architects of Houston, a firm that specializes in the healthcare service market. “They led the way in educating us in healthcare projects that had been constructed around the country,” says DeLeon. “This collaboration was effective in blending our conventional institutional
guaranteed the completion of the project within a
building practices with commercial elements that
set price and schedule. “They brought a first class
were introduced for better overall alignment with the
team to help us deliver the project, and coupled with
campuses’ medical practice plan.”
the design architects and engineers, the project was delivered successfully,” says DeLeon.
Manager-at-Risk method of delivery, which means
A Landscape Change for the UT System Campus
the construction manager provided budget, schedule
The MARC project involved approximately two years
and constructability expertise during design, and
of design and planning, and two years of construction.
services. The UT System opted for the Construction
rooms, completely finished out and equipped with beds,
shelled areas in the ambulatory surgical center and the
outlets, and swing arm tablets for data entry. We then had
imaging area to allow for future expansion.”
visualize how they would work with the patients. Based on
Architects for UT System projects are selected in
Contractors, provided construction management
as well as how busy equipment was. We also provided
nurses and physicians inspect the mock-ups to help them
serve as a great template for all of our projects.”
A local San Antonio firm, Barlett Cocke General
“One tool we used was the building of mock-up exam
Future Projects
their input, we were able to refine minor elements of the
In a system the size of UT, there is always construction
design for things such as cabinet placement, door swings
underway. With the intention of drawing elite
and privacy curtains,” says DeLeon.
researchers, they are currently building a world class
Once construction was nearly three-quarters of the
research facility designed by an international architect.
way complete, the UT project managers began providing
The $150 million dollar project is about 12 months from
formal walking tours of the building to the physicians and
completion. Six major areas of research will be housed
nurses. This was done in order to help the staff begin to
in the 175,000 square foot facility, and will feature
visualize transitioning into the new setting.
the latest in available technology to study infectious
“It was challenging to design for the infrastructure,” says Lew. In medical imaging for instance, it was important to have the latest technology. To take advantage of the
diseases relevant to South Texas and the world. by T. M. Simmons
latest equipment, final decisions were not made until well past the initial design stage and well into construction. “A lot of the imaging area wasn’t really designed until the equipment was selected so it occurred out of sequence. Although it’s a challenge, advancements in medical equipment sometimes necessitate selections late in construction,” says Lew.
HCE EXCHANGE MAGAZINE Real Issues : Real Solutions
49
JAN/FEB
2011
Real Issues : Real Solutions
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