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Real Issues : Real Solutions
All Children’s Hospital Realizing the need
OCT/NOV 2011
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Real Issues : Real Solutions
CONTENTS
06 All Children’s Hospital
IN-FOCUS STORIES 12 American Pathology Partners, Inc. 18 Memorial Hermann Sugar Land Hospital 20 Northwest Medical Center 22 PinnacleHealth 24 Clinical Laboratory Partners, LLC 28 Cornell Scott-Hill Health Center 32 Geisinger Health System 36 The Seton Healthcare Family 38 Greater Hazleton Health Alliance 42 Lincolnwood Place 46 Naval Hospital 50 NCH Healthcare System 54 Parkland Health & Hospital System 58 St. Rita’s Medical Center 62 United Health Centers of the San Joaquin Valley 66 Cookeville Regional Medical Center 70 Gothenburg Memorial Hospital 72 Coastal Family Health Center
HCE EXCHANGE
75 Larkin Community Hospital 78 Lakeland HealthCare 80 Norwalk Community Health Center 82 West Gables Rehabilitation Hospital 84 Health Inventures 86 Rockingham Memorial Hospital
OCT/NOV
2011
All Children’s Hospital
Patient- and family-centered care is becoming standard across all of healthcare, but nowhere is it more important than in children’s healthcare. Family has always been a large part of care for children, and the trends toward private rooms, decentralized nursing, and advanced technology are continuing in this area. One leader in children’s healthcare is All Children’s Hospital in St. Petersburg, Fla. The hospital is located on Florida’s west coast along the Gulf of Mexico. In the summer of 2009, All Children’s moved into a brand-new 259bed hospital. The entire project consisted of a 795 square-foot hospital, a 253,000 square-foot outpatient center and a 66,000 square-foot central-energy plant, plus a parking deck. The hospital is beautiful, providing a soothing, welcoming atmosphere for patients and their families. Every detail was considered to provide comfort and high-quality care no matter what happens.
Real Issues : Real Solutions
Realizing the need
and stay within the $287-million budget for the
All Children’s Hospital has been providing care
hospital and the $49-million budget for the central-
Mercury Medical
for more than 80 years, and its current facility had
energy plant.
Your Need . . . Our Innovation
been in use since 1967. “We had added on to the existing facility, but
materials was skyrocketing, and Strouse’s team continued seeking ways to control costs. Contrac-
service we needed,” said Tim Strouse, vice presi-
tors were given about 40 percent of the cost sav-
dent of facility operations . “We had a number of
ings, and overall, the project came in on time and
issues that could have been solved individually, but
$10 million under budget.
needed a new facility.”
Planning for the future
Some issues with the old building included
Early in the process, Strouse said the project team
inadequate floor-to-floor heights to accommodate
agreed upon a set of guiding principles that every-
new equipment, 85 percent semi-private rooms,
one could stick to throughout the project to help
and insufficient HVAC and electrical panels to meet
direct decision making. One principle was that the
the demands of advanced technology. All Children’s
building would last at least 40 years. As with most
decided to build a replacement hospital about two blocks from the old site. The previous outpatient building was converted into a rehabilitation facility.
space for adaptation.
All Children’s brought the contractors and designers in early to help keep costs under control
height, increased power, and allowed for vertical TM
and horizontal growth. We tried to think of everything we could for the future, and within the first
When construction began, the cost of raw
we reached a point where we couldn’t maintain the
when you looked at them together, it was clear we
pansion,” he said. “We increased the floor-to-floor
For over 2 decades Mercury Medical has partnered with All Children’s Hospital providing the latest in “cutting edge” technologies for optimal patient care.
year of being open, we already faced pressure to
Mercury Medical’s sales specialists offer innovative purchasing options providingaffordable solutions to allow rapid adoption of technological advances. We supply all resources in education and training including specialists ensuring that the transitionto premium high-tech patient care is seamless.
ters and man-made occurrences. All Children’s is
add technology.” In addition to anticipating advances in technology, the new hospital is prepared for natural disasin an area vulnerable to hurricanes, and Strouse said the planning team applied many lessons learned from past hurricanes, including Katrina, to implement features that would keep the hospital running no matter what crisis could strike. tors that allow the hospital to run at 100 percent
new construction, this requires making assump-
Keeping health care ahead of the curve with the latest innovations is our specialty . . . and has been for nearly 50 years.
tions about the future of technology and planning
www.mercurymed.com
disaster. All mechanical equipment is located on
“We allowed space within all electrical panels,
The building has six 200-horsepower generapower for up to two weeks in the event of a natural the fourth floor rather than the basement in order to avoid the possibility of flooding.
wiring molds, cable trays, and other areas for ex-
HCE EXCHANGE MAGAZINE Real Issues : Real Solutions
9
Pub Master 8.5" x 11" (100% of orig size)
Taking care of patients and their families Not only is the hospital prepared to care for patients in the event of any emergency, but the facility
THE HEALTHCARE ENVIRONMENT IS GROWING IN THE RIGHT DIRECTION.
also provides upgraded features to help patients and their families feel more comfortable. Strouse
Thanks to you.
said the planners incorporated evidence-based design involving family-focused care with individual
Making design decisions that affect the health of patient-centered environments isn’t easy.
research program, but through the integration with Johns Hopkins, All Children’s looks to expand its opportunities. All Children’s maintains its mission to provide the best care to children and has left nothing to chance in all its planning to achieve that mission. By Patricia Chaney
rooms that have space for family members, a
Collaboration with you has led to breakthrough flooring solutions for surgical suites, neo-natal units, ICUs, patient care rooms, high traffic areas and many others. Listening to your needs has resulted in rubber flooring that is also bacteriostatic, resistant to micro-organisms, easier to clean, can reduce noise and contains no PVCs.
dedicated floor for the neonatal intensive care unit,
It all starts with you. You and your challenges. You and your world. You and nora.
decentralized nursing stations, and local artwork
playrooms, a family resource center and a rooftop playground. The designs also incorporate natural light, meant to inspire the children and their families.
800-332-NORA www.nora.com/us/healthcare26
Most recently, All Children’s Hospital became integrated with Johns Hopkins Health Systems.
Follow us: @noraflooring
The hospital already has an excellent teaching and
3230-2119-Health-HP-heemD1.indd 1
10/6/11 10/ 0/6 /6/ 6/11 9:17 :17 AM AM
Nora Systems Your challenges in maintaining and operating a
“One of our guiding principles was that we would
healthcare facility are diverse and unique. Hospitals
take care of our children no matter what,” Strouse
need to be safe, comfortable, hygienic and effi-
said. “We have learned that you can’t always de-
ciently maintained. With durable, no-wax flooring
pend on outside help, so we have made the hospital
from nora, you can address these needs in all areas
as self-sufficient as we can for a long period of time
of your facility, and provide a clean and quiet space
in the event of a disaster.” Planning for the hospital began before Katrina
ideal for patient comfort and recovery.
hit the Gulf Coast, but All Children’s made one significant change in planning upon seeing the effects of Katrina in New Orleans. After watching patients being transported from hospitals to open areas because the helipads could not accommodate a military helicopter, the hospital chose to build a helipad that could handle a full-sized military helicopter. All Children’s is also prepared for biochemical and biohazard events. The hospital has a decontamination unit as well as an isolation wing.
HCE EXCHANGE MAGAZINE Real Issues : Real Solutions
11
02 | American Pathology Partners, Inc. CortexQuarterPageAd_new101911.pdf Cort ortexQuarterPageAd rte exQ Quart rterPageAd_new101911.pdf new1019 f 1 10/19/2011 10 0/19 9/2 2011 6 6:24:14 :24:14 PM
American Pathology Partners, Inc. As healthcare undergoes a paradigm shift of historical proportions, an underlying theme of partnership as opposed to ownership has taken over the traditional relationships of hospitals and physicians with ancillary health services.
Anatomic Pathology Reporting Software
&
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American Pathology Partners, Inc., is an example of this partnership trend. With headquarters located in Brentwood, Tenn., AP2 was founded and capitalized in early 2008 and owns and operates local and regional anatomic pathology labs in partnership with pathologists.
Thanasis Papaioanu, Chief Information Officer & Chief Development Officer
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Currently, AP2 has three primary partners—UniPath in Denver, Colo.; Eastern Carolina Pathology in Wilson, N.C.; and Palm Beach Pathology in West Palm Beach, Fla.
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For the love of pathology
He added, “We describe ourselves as a nationwide
vices to its partner labs. According to their website,
Thanasis Papaioanu, co-founder, chief information
network of laboratories with a local, regional, or
www.ap2.com, partnering with AP2 gives that lab
officer, and chief development officer of AP2, said
super-regional focus.”
greater access to growth capital, sales and market-
that he and his original partner, Edward Dooling,
Once AP2 acquires a lab, that lab continues to
SAVINGS
www.cortexmed.com
ing, information technology services and support,
were both lab professionals who loved every aspect
operate under its original brand name, thus en-
senior management support, human resources,
of pathology from the clinical side to the business
abling the lab to maintain the identity it has already
and a host of other services.
side to the various industry dynamics.
built up within its community or region. Papaioanu
urologists and gastroenterologists) and the uncertain reimbursement environment in healthcare.
tunity to consolidate a very fragmented area of the
tralized. AP2 supports its network laboratories
Founded on the heels of crisis
healthcare sector and provide a better product than
from its “centers of excellence,” offering subspe-
AP2 has taken risks from the beginning, and these
three to five years, he predicts that AP2 will have a
what the larger national labs were able to produce.
cialty services that are hard to replicate locally,
risks have paid off in growth, despite the volatile
nationwide footprint.
This led to the development of the partnership
such as flow cytometry or molecular diagnostics.
nature of the economy during its 2008 founding. In
Based on their experience, they saw an oppor-
describes the approach as distributed and decen-
Regardless, Papaioanu’s goal is to grow AP2 to a point where it covers the entire nation. In the next
work collaboratively as partners as opposed to the
Papaioanu said. “They are not employees. What we
mere months after the U.S. financial system had
Devoted to their constituencies
more traditional model where pathologists are
are trying to spread is independence. We want our
collapsed.
In addition to providing support services for its lab
employees.
pathologists to be independent, and we do not want
model in which the business side and pathologists
“We work with pathologists as partners,”
fact, AP2’s first acquisition came in December 2008,
“We were very pleased that we were able to do
partners, Papaioanu explained that AP2 has two
to manage their affairs. They are separate self-
that, and we are very happy with our investors that
additional constituencies—physician offices and
marry what makes a national laboratory successful
managed entities, and it is a radical departure from
have remained calm in the midst of a very difficult
hospitals. At this time, they have close to 16 hospi-
and a potent competitor with what makes a local
what has been happening in our industry. We work
financial situation for everybody,” Papaioanu said.
tal partners to whom they provide lab services, and
lab successful and take the best of both worlds, and
with them very collaboratively in developing and or-
“And I think that speaks to the very solid business
for the tests that they don’t perform in-house, AP2
you have a laboratory where we can create more
ganically growing the business after a transaction.”
plan that we have put together.”
works with other laboratories.
“We thought maybe it was an opportunity to
value for our physician clients and their patients as
In addition to clinical and technical support
well as our pathologist partners,” Papaioanu said.
services, AP2 also provides business support ser-
SIMPLICITY
Currently, the biggest challenges AP2 is facing are internalization of pathology by specialists (e.g.
“We are here to provide high-quality laboratory services,” Papaioanu said. “High quality does not
HCE EXCHANGE MAGAZINE Real Issues : Real Solutions
13
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just mean performing a test better. It means also providing a high level of service and a better user experience than what physicians and their staff have been accustomed to.” AP2 exists, he said, to serve both physicians and hospitals. While most venture-backed laboratories in the industry focus on the outpatient market and physician offices, AP2 places a heavy emphasis on hospitals. Papaioanu said AP2 likes hospitals and is there to serve hospitals, viewing them as equally important as their physician-office business. For Papaioanu and AP2, it’s about partnership for the sake of high-quality healthcare, no matter what the marketplace may bring. He is dedicated to his belief in the partnership model and passionately sees it as the doorway to the future. “As a model, it’s not an easy model,” he said. “It’s like a marriage, working with a partner that
HCE EXCHANGE MAGAZINE Real Issues : Real Solutions
17
03 | Memorial Hermann Sugar Land Hospital
Growing to meet community needs Sugar Land Hospital is a 77-bed not-for-profit facility with about $108 million in net annual revenue. It was recently named to the Thomson Reuters 100 Top Hospitals list. Even with just five years in business, Sugar Land Hospital has expanded services, adding invasive cardiology and growing its main service lines of orthopedics and women’s and children’s. “As a full-service community hospital, we felt that invasive cardiology is a necessary service,” Brown said. “We are the last facility in our market to add this service and are working toward creating the right structure so that the program excels in this market.” With an appeal to the Memorial Hermann healthcare system, Sugar Land Hospital was able to purchase two interventional labs. Brown credits much of the hospital’s prosperity to its surgical volumes, and it has added operating rooms and capacity in the women’s labor and delivery unit as well. Future plans include expanding the hospital’s primary-care base, providing a more robust
total-joint program, and creating closer alignment between primary-care providers and specialists to help increase the elective procedure volumes at the hospital. Sugar Land has recently expanded into radiation-therapy services through a joint-venture with Texas Oncology.
Starting clean and paving the way Starting clean as a new facility has its challenges but can be an advantage, especially as many established hospitals are trying to adapt their facilities to changing technology. Sugar Land Hospital was built with the latest equipment and technology, offering all-private rooms and amenities for the comfort of patients and their families. The hospital is also at Stage 6 with electronic medical records implementation using the Cerner suite of products. To help remain successful, the hospital has the advantage of being part of the Memorial Hermann healthcare system, the largest not-for-profit system in Texas with 11 hospitals and numerous specialty programs and services. “Growth still remains a challenge, although we have seen great success so far,” Brown said. “As a new facility we have not yet hit the sweet spot of covering our depreciation on new construction and
Memorial Hermann Sugar Land Hospital Finding a path forward in an ever-changing environment and maintaining revenue streams is challenging for established hospitals in the United States. Imagine being a relatively new community hospital, trying to thrive in a highly competitive market. Memorial Hermann Sugar Land Hospital, a full-service, acute-care hospital, has been establishing its position in the competitive healthcare market of Houston, Texas. In about three years this healthcare market has grown from 300 beds to 700, but Sugar Land has been able to establish and maintain its market share in its five years of operation.
Jim Brown, CEO
The hospital has excelled in many areas including quality and physician satisfaction. According to Jim Brown, chief executive officer of Memorial Hermann Sugar Land, the hospital has ranked in the 94th percentile nationally in physician-satisfaction scores in 2010 and 93rd in 2011. “Our hospital’s success has shown that you don’t have to be the largest provider in a market to deliver a high level of service,” Brown said. “You just have to have a balanced approach with quality care, good outcomes, and strong physician relations.”
allocation of corporate overhead. But we have been
in the employment model. I think this can be
ahead of schedule in that journey.”
achieved, but it requires political savvy and trust.”
A new facility not only starts clean with technol-
Brown has focused a great deal on building that
ogy and applying the latest amenities for patients
physician trust and maintaining positive relation-
and families, it also starts clean in management
ships with employed and independent physicians.
and operations. All hospitals are doing their best
Collaboration with physicians and engagement are
to plan for an unknown future of accountable-care
two key values Brown promotes as CEO.
organizations and physician alignment. Physician-employment models and alignment
Fostering alignment with primary-care physicians and the specialists that help support the
between primary-care physicians and specialists
hospital has been a strategy for growth as well as a
has been a major focus for Sugar Land Hospital.
plan for future changes.
“As a system, Memorial Hermann is progres-
Through these strategies and the rigorous
sive as it relates to physician alignment, the poten-
quality standards the hospital maintains, Sugar
tial development of accountable-care organizations,
Land is uniquely poised to establish itself as a
and health-information exchange,” Brown said.
market leader.
“At Sugar Land, we are in an environment where physicians of multiple specialties are seeking the
by by Patricia Chaney
hospital for employment. A constant challenge is how to embrace them without alienating our loyal, independent physicians who are not interested
HCE EXCHANGE MAGAZINE
19
04 | Northwest Medical Center
Northwest Medical Center
grams and services that meet the healthcare needs
Dianne Goldenberg, RN, CEO
Technology is ever-changing in the healthcare industry. All hospitals work hard to stay abreast of the latest state-of-the-art equipment, but technology is also advancing how physicians receive medical information, how medical records are stored, how patient care is delivered, and how hospital news is communicated.
of residents and businesses in the South Florida
One hospital, Northwest Medical Center in Margate, Fla., is making progress in all areas of technological advancement. Northwest is a 215-bed medical center and healthcare complex with approximately 800 employees. The hospital offers women’s and children’s services, minimally invasive surgery, a bariatric-surgery Center of Excellence, a certified Primary Stroke Center, and most recently, open-heart surgery.
168,308 hospital admissions.
In August 2010, the hospital opened the Heart and Vascular Institute, the only Cardiac Level II Licensed Program in northwest Broward County. And the hospital is planning a $23-million expansion to accommodate cardiovascular operating rooms, intensive-care units, and support structures for the open-heart facility that is scheduled to open March 2012.
and Treasure Coast communities. HCA East Florida hospitals cared for more than one million patients in 2010. This care included 520,147 visits to our emergency rooms (ERs) and HCA East Florida has over 4,500 physicians on staff, and more than 14,000 employees provide “We always try to give consumers information about facilities, services, what we provide,” she said. “As avenues of communication change, we change, too.” Another service that Northwest provides to its patients is digital billboards seen from the road that
“This expansion is exciting for our community,” said Dianne Goldenberg, RN, chief executive officer. “People used to have to travel for open-heart surgery, and now they can receive continuity of cardiac care right in their own backyard. We think the new facility will be a perfect blend of state-of-the-art equipment with superior physicians and clinical staff.”
display current emergency-room wait times. Pa-
Goldenberg said the hospital is also making investments in medical technology with the purchase of a da Vinci-Si Robotic Surgical System, installation of radiology PACS, and upgrades to interventional radiology and diagnostic imaging services.
the country, and publishing those times where pa-
tients can also find the wait times on the hospital’s website or have them sent to their phones. Wait times are a source of stress for patients throughout
the quality foundation for delivering care to their patients safely, effectively, and compassionately. Its hospitals are Joint Commission Accredited, with designations that include Accredited Chest Pain Centers, Primary or Comprehensive Stroke Centers, Centers of Excellence, a trauma center in St. Lucie County, and many others. For more information, please visit HCA’s website at www.hcaeastflorida.com. by Patricia Chaney
tients can view them before coming to the hospital can help set expectations.
Adapting to the future As technology changes in communication, equip-
Piloting technology
positive impact on patient safety has helped staff work
ment, and patient expectations, Northwest plans to
In addition to medical equipment, there’s a height-
through the barriers.
stay involved and moving forward.
“We are ranked among the highest in the nation for
ened awareness and demand in the industry for
“We are always looking at what we need to
receiving imaging data, results, and other patient
core measures,” she added. “We focus on evidence-
enhance the patient experience,” Goldenberg
information on handheld devices.
based medicine, and along with our EHR initiative, we
said. “Our goal in the future is to become a high-
In April 2011, HCA and three of their South
are tying quality, safety, and technology together to
level tertiary-care center for the people in North
Florida hospitals, Northwest Medical Center being
provide the best care and great clinical outcomes.”
Broward County. We have a dedicated medical staff
one of them, were the first hospitals in the nation
and are willing to grow to meet the needs of our
allows clinicians to view ECG data in real-time. The
Using the latest technology for communication
system uses data from the GE Healthcare MUSE
Northwest Medical Center is dedicated to providing the
respond to healthcare reform. It is looking at strat-
Cardiology Information System and makes it avail-
best care possible to its patients and to being a commu-
egies for physician alignment and other challenges
able on the physicians’ iPhones and iPads.
nity partner. Part of that role involves communicating
expected to come.
to use the AirStrip Cardiology software system that
Northwest has also implemented computerized physician order entry (CPOE). “We’re getting a head start with the electronic medical records (EMR) initiative,” Goldenberg said.
effectively with patients or potential patients to be sure
community.” As with all hospitals, Northwest is preparing to
Northwest Medical Center is part of the Hos-
they know about the care they can receive at Northwest.
pital Corporation of America’s (HCA) East Florida
With many services, awards, designations, and renova-
Division. HCA’s East Florida Division is a compre-
tions, Northwest has a lot to share.
hensive network of 13 hospitals, numerous out-
Goldenberg said the hospital regularly uses Face-
“CPOE ensures numerous benefits to our patients,
patient surgery centers and imaging facilities, an
staff, and physicians. The hospital has faced the
book and Twitter to share news and updates. It also
integrated regional laboratory, physician practices,
common challenges associated with moving toward
maintains a blog with health-related articles on
medical education and training programs, and a
electronic medical records, but focusing on the
its website.
complete continuum of specialized health pro-
HCE EXCHANGE MAGAZINE Real Issues : Real Solutions
21
05 | PinnacleHealth
PinnacleHealth
Phil Guarneschelli, COO Hospitals have always been dedicated to providing high-quality, safe care to their patients, but as they look toward a future of payment for performance, keeping patients —and family members or caregivers—happy has become just as important as quality. Most healthcare organizations are adjusting to this with patient and family-centered care initiatives and a focus on HCAHPS scores. PinnacleHealth System, a non-profit healthcare system in central Pennsylvania, has been working hard for the past three years on initiatives that will prepare them for the future of healthcare delivery. PinnacleHealth System consists of three hospitals with about 600 beds and a teaching hospital with eight residency programs. In 2009, the system began a cultural change to improve quality and safety, with a focus on the Centers for Medicare and Medicaid Services (CMS) core measures and other state and federal-quality indicators; improving communication among staff, physicians, and patients; and improving patient satisfaction.
core measures. It involves the coordinated efforts of all hospital employees and physicians from leadership to housekeeping. Improving communication among staff was a necessary step toward improving quality. PinnacleHealth leadership implemented communication projects, including hand-off communication, medication reconciliation procedures, rapid response teams, and documentation. Staff began using SBAR when transitioning patient care. SBAR is a technique used by many hospitals and stands for situation, background, assessment, and recommendation. In addition to larger initiatives, PinnacleHealth recognized that confusion also occurs in documentation, and simple guidelines, such as using approved abbreviations and working on legibility, improved patient care. Finally, the system has been looking toward the future and making huge strides in patient satisfaction. Some initiatives include enhanced wayfinding, a patient and family-centered care team, an emergency department customer perception workgroup, and employee focus groups. With help from the Studor
Implementing continuous improvement initiatives
Group, PinnacleHealth initiated AIDET, a guide for patient communication that stands for acknowledge, introduce, duration, explanation, and thank you. “Everything we do at PinnacleHealth is focused
Beginning in 2009, PinnacleHealth saw drastic improvement in quality indicators such as infec-
on patient care and quality,” said Phil Guarneschelli,
tions and core measures for heart failure, pneumo-
COO. “We recognize that finances are important, but
nia, acute myocardial infarction, and surgical care.
that stability comes with a quality-driven healthcare
For most measures, PinnacleHealth has met or
system and one that puts patients first.” These initiatives all support the key values of Pin-
exceeded the national average. Achieving improved quality is more than just decreasing infections or attaining certain scores on
nacleHealth’s leadership--transparency, accountability, and collaboration.
Moving beyond implementation After a few years of noticed improvement throughout the system in these initiatives, PinnacleHealth has been able to expand and focus on capital projects, as well as physician alignment. Last year, the Harrisburg Campus opened a new emergency department. The hospital sees more than 58,000 emergency-department visits per year, and the previous facility was designed to accommodate about 40,000. With the new emergency department, the hospital has focused on ways to lower
said that PinnacleHealth is looking at ways to align
wait times and improve throughput.
physician-outpatient visits with the hospitals.
PinnacleHealth has been using a number of
“We have an outpatient business and a hospital
Lean Six Sigma projects to increase productivity
business,” he said. “There has been a shift toward
throughout the system and has encouraged all staff
more outpatient care, and we need to change our
to get involved in training. Four employees have
business model to one of integrating our physicians
completed black-belt training, more than 60 have
into the healthcare-delivery network.”
completed green belt, and more than 100 employees have attained yellow belts. Other projects in progress are a new cancer
Cardiology is one area in the works to do this. Two of the region’s most experienced cardiology practices, Moffitt Heart and Vascular Group and
center, which opened in the spring of 2011 on
Associated Cardiologists, joined PinnacleHealth’s
the Community Campus, and upgraded women’s
Cardiovascular Institute in 2011.
services at the Harrisburg Campus. The women’s
“We are trying to keep everyone aligned as we
services project will focus on antepartum patients,
move toward our goals,” Guarneschelli said. “We
creating all private rooms on a separate floor. In all,
have been successful so far and have a great team
construction projects are budgeted at $60 million.
of people.”
Another major focus at PinnacleHealth is physician alignment. Many healthcare organizations are
by Patricia Chaney
examining ways to bring physicians into the organization through integrated systems. Guarneschelli
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06 | Clinical Laboratory Partners, LLC
Clinical Laboratory Partners, LLC At one point in time, Clinical Laboratory Partners (CLP), was struggling to stay alive. As James E. Fantus, president and CEO, describes that time, CLP should have dissolved. Now, it is one of the largest laboratories in the state of Connecticut with approximately 85 locations, 900 employees, and a budget of $140 million per year.
James E. Fantus, President & CEO
A wholly owned subsidiary of Hartford HealthCare (for whom Fantus also serves as vice president), CLP offers a broad range of services to patients and physicians, chief of which is lab testing. Testing services include anatomic pathology, molecular diagnostics, chemistry, hematology, microbiology, and cytogenetics. In addition to providing customers with these services, CLP also accepts all major insurance plans. Fantus points out that not all laboratories can say that, and he emphasizes that this is one of the many benefits that goes along with their Hartford HealthCare relationship. Furthermore, CLP’s primary focus is on physicians, he said. Hospitals and nursing homes are also serviced by CLP.
Out of the ashes and into growth One thing that has marked Fantus’ tenure at CLP is growth even during the worst economic crisis since the Great Depression. Fantus said if one saw CLP’s statistics on a graph, one wouldn’t even think there was a floundering U.S. Economy . “Last year has probably been one of the worst
knew it. But I knew it. So for me, this was the best do, and everything I’ve predicted has happened as I predicted it.” CLP’s success under Fantus’ leadership is the result of effective planning and metrics. The company has gone from being the lowest performer for their health system in percentage of margin to the
years that anyone alive today can remember, as
best.
was the year before,” he said. “We had record busi-
Success through basic marketing
ness and profit growth.” In fact, CLP is growing at approximately 15 percent year over year in terms of real volume. “Before I came here, this company was not in a good place,” Fantus said. “They actually should have closed it down and just walked away from it. But when I needed to move on from my previous job--I was the CEO of a laboratory in another state--and I looked for a place to go, this particular organization had everything going for it, just nobody
had been cut down to a point where the company
opportunity because I knew exactly what I had to
Fantus believes his marketing background contributed to the success he has experienced at CLP. In trying to get the company to turn around, his predecessor kept cutting costs and paying lower salaries. However, the company ended up losing business because it had cut resources so far that customer service (e.g., answering phones quickly, responding to problems efficiently, etc.) suffered. Resources
QIAGEN Inc. QIAGEN Inc. is the worldwide leading provider of sample and assay technologies for molecular diagnostics. Our instrument platforms allow laboratories to automate workflows from sample preparation, to assay setup and detection. Manufacturer of the digene HC2 HPV DNA Test, QIAGEN is the leader in molecular cervical cancer screening and is continuing this leadership into personalized healthcare.
couldn’t compete with anybody. Fantus’ approach was to grow business. As he said, “That’s a lot more fun than cutting back. Things that don’t grow die.” His first move was to hire enough people to address the customer-service problems that CLP was having. Fantus wanted the product they offered to be something that physicians would want. Then, he went on a tour of sorts, visiting the company’s largest customers, mainly physician groups, who had remained loyal to CLP in spite of its trials. Fantus’ goal was to understand what his company was doing wrong. Since CLP had no idea how to market its services, Fantus then assembled a strong sales and marketing team. He acknowledges that this was a costly gamble, but he said it was necessary to get volume growing again.
HCE EXCHANGE MAGAZINE Real Issues : Real Solutions
25
His final move was more subtle and delicate. Fantus said he wanted to make the work CLP does a personal matter for his employees. “I tell every employee in orientation that we want them to give to the company in a way that they wouldn’t hesitate to send their mother or father here to get lab work done. I think as we get people to feel that way, the job becomes more personal.”
The difficulty of regulation Of all the challenges facing CLP today, HIPPA regulations are probably some of the more difficult with which to deal because of the serious consequences for not following them and the amount of resources it takes to maintain a secure patient record. “We have to protect that information both internally and externally, and so does everybody in healthcare,” Fantus said. “And it’s really one of
Roche Diagnostics As a global leader in healthcare, Roche Diagnostics offers a broad portfolio of tools that help healthcare professionals find the right treatment for patients and deliver the best patient care to improve, prolong and save lives. Our partnership approach in conjunction with the cobas® 6000 analyzer series has helped CLP provide reliable, quality results and streamline their lab operations.
“I tell every employee in orientation that we want them to give to the company in a way that they wouldn’t hesitate to send their mother or father here to get lab work done.I think as we get people to feel that way, the job becomes more personal.” those regulations that is adding a new dimension to providing health services.” He added that the low reimbursements for the federal payers—people who don’t have insurance-exerts a great deal of influence on all of the organization’s cost-shifting. Fantus believes it’s a result of federal payers not contributing their equal share to the system. However, none of these factors dissuades him from pursuing a future of expansion.
© 2011 Roche Diaagnostics, North America. 467-51012-1011
“Our goal is to be the biggest lab in the state,”
Innovation focused on improving the lives of patients.
Fantus said. “We have one other competitor to overtake. We’re still a year or two away from that, where we would be the biggest player. And in this environment, size really does matter. The small organizations are going to find it very difficult to compete. We’re able to serve patients anywhere in the state. We’re the kind of organization that a payer wants to deal with.” by Pete Fernbaugh
Roche is a world-leader in pharmaceuticals and in-vitro diagnostics. Our personalized healthcare strategy aims at providing medicines and diagnostic tools that enable tangible improvements in the health, quality of life, and survival of patients. http://www.roche-diagnostics.us
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HCE EXCHANGE MAGAZINE
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07 | Cornell Scott-Hill Health Center
Continental Contracting Inc. As with other healthcare organizations, Cornell Scott-Hill Health Center has implemented electronic medical records to attain meaningful use. The center implemented GE Centricity for medical and dental, but found that no one product had the depth needed for the behavioral-health services offered. The center was able to have GE collaborate with MindLinc from Duke University to offer an integrated medical record, with an in-depth behavioral-health product. “The partnership is unique in that GE came to the table after recognizing they could benefit greatly from our deep understanding of behavioral health in a primary-care setting and the challenges of true integration,” Taylor said. ”The opportunity to take our industry-leading knowledge and incorporate that into their product line is a great benefit to them. And of course, partnering with a global leader in healthcare technology gives
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us a certain sense of confidence in the outcome. We know the product will deliver results for our patients through efficiencies and more robust reporting capabilities.”
Cornell Scott-Hill Health Center Community health centers face unique challenges and patient populations with perhaps a greater focus on their surrounding areas than many other healthcare organizations. Cornell Scott-Hill Health Center is a federally qualified community health center that has been serving residents of New Haven, Conn., neighborhoods since 1968. About 65 percent of patients receive Medicaid, and 58 percent are below the poverty line. Seeing about 33,000 patients per year, the health center offers a range of programs including medical, dental, and behavioral health.
Michael Taylor, COO
“We have one of the best models of integrated medical, dental, and behavioral health,” said Michael Taylor, chief operations officer. “We offer inpatient detox and outpatient intensivetherapy services. We are where everybody else wants to be.”
Growing with the community
pregnant teenagers, HIV/AIDS education, a 29-bed
The center was founded through a collaboration
transitional shelter for homeless men, and a child
between the community and the Yale School of
and family-guidance clinic.
Medicine in 1968. Cornell Scott-Hill Health Center
drug and alcohol detoxification program, a 44-bed
“We are no longer a mom-and-pop shop,” Taylor
was the first community health center established
said. “We are raising the bar on skills and compe-
in Connecticut and has come a long way since its
tencies of our employees and on quality. This takes
origins. The center now has 16 care sites, numer-
significant infrastructure to make it work.”
ous collaborations with other healthcare organiza-
Taylor has been a trainer for the National As-
tions, more than 550 employees, and an annual
sociation of Community Health Centers for years
budget of $52 million.
and said he regularly hears from health centers
It has five school-based health centers and a
across the country about the challenges associated
dental school-based health center. The center of-
with recruiting and training staff, especially as the
fers programs including outreach to homeless indi-
centers grow and add partnerships.
viduals, birth-to-three services for developmentally delayed children, social/educational services to
Health centers are evolving and for many community health centers, the training and skill
HCE EXCHANGE MAGAZINE Real Issues : Real Solutions
29
costs, as well as absorb the costs of malpractice insurance which is one less expense for our provid-
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Providing “compassionate, quality, accessible and culturally appropriate health care�
Changes on the horizon During the past two years, Cornell Scott-Hill Health Center has been making major changes. For the first time in its history, the center had a change in leadership with the addition of a new chief executive officer. Jamesina Henderson assembled a new ex-
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ecutive team, and the center has made huge strides in improving the environment of care for patients.
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was through staff training. He said all caregivers are receiving new training in customer service and communication skills.
Outreach is another shift made by the new execu-
“We want the employees who work here to pas-
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tive team. Historically, Taylor said, the center hasn’t
sionately care about the people who walk through
spent as much effort in reaching out to educate the
our doors and for that passion to show,� he said.
community about its services.
The center is making many other operational
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changes as well from the way it hires staff to how
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it recruits providers. For the first time in 30 years, the center revised its sliding-fee discount program. Taylor said they are also looking at operating procedures and incorporating expectations into annual performance reviews.
development of staff lagged behind for many years. Health centers now have such a dependency on technology, for example, that it has impacted hiring practices. It’s also put a greater demand on the skill development of existing staff. Additionally, everyone knows that primary care is in demand and there are simply not enough providers in the primary-care field. Most newly graduated medical-school students are pursuing specialty care for many reasons, chief among them being that they can get a greater return on their educational investment. “While it is a challenge for all health centers to
“We’re reintroducing this organization to the
“We want the employees who work here to passionately care about the people who walk through our doors and for that passion to show.�
communities we serve so we are better positioned to be available and be known by those who can benefit from our presence here,� he said. Through these efforts, Taylor said he sees the organization becoming a larger player within the state and offering other specialties the community needs. “Community healthcare is an industry in transition,� Taylor said. “The founders of this movement back in the late sixties are relinquishing control to a new collection of people who bring vast experience from both the non-profit and the for-profit sectors. They have new skills, and they are helping organizations like ours take the next step in their evolutions. “As leaders in this field we need to be cognizant of the ever-increasing need for employees that come with a baseline skill set that includes customer service, flexibility, and adaptability, because this industry is constantly changing.� by Patricia Chaney
find and keep high-quality talent in primary care, we do have many advantages over other institutions,� Taylor said. “These include programs that allow us to reimburse providers for educational
HCE EXCHANGE MAGAZINE Real Issues : Real Solutions
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08 | Geisinger Health System
The smaller projects can be handled by the inhouse architects and engineers. Gladish and his staff act as general contractor utilizing internal superintendents, project coordinators, project
Geisinger Health System
managers, and laborers. For larger projects that Geisinger’s facilities group is broken into planning,
would consume all of the internal resources,
design, and construction. Gladish and others
Geisinger goes outside.
in the group have experience acting as general
William Gladish, AIA, Director of Construction
As clinical care is shifting toward a focus of decentralized decision making, so facilities construction is following a similar track toward teamwork throughout the entire process. Many facilities recognize the importance of bringing in members of a design and construction team early to establish expectations and priorities.
contractors on smaller projects for the health
Award-winning teamwork
system. This gives them detailed insight on what to
Geisinger received the 2010 Vista Award for New
look for in partners.
Construction for its Critical Care Building at the
Geisinger Health System in rural Pennsylvania has perhaps mastered this team approach better than other health systems. “We think the best way to have great results is to have a great team,” said William Gladish, AIA, director of construction. “We need to bring in participants early and make sure they are compatible with our designers and have a philosophy that fits ours.”
Geisinger employees about 13,000 people
Geisinger Wyoming Valley Medical Center site.
across two major hospitals and a number of clinics
The Vista Award is presented by the American
and other facilities spread over about 40 sites in
Society for Healthcare Engineering of the American
northeastern Pennsylvania. The facilities group has
Hospital Association and the American Institute
about 30 people and receives numerous requests
of Architects Academy of Architecture for Health
for upgrades, new equipment, expansion, and other
and recognizes teamwork in healthcare design and
construction projects.
construction.
HCE EXCHANGE MAGAZINE
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A commitment to sustainability Gladish said the health system has a commitment to teamwork and sustainable elements. All new buildings must be LEED certified, and nearly 10 existing buildings have some LEED certification. In addition to new construction, Geisinger has retrofitted existing facilities to be more energy efficient. â&#x20AC;&#x153;We think that LEED certification serves our purposes well,â&#x20AC;? Gladish said. â&#x20AC;&#x153;We are a cost-driven organization, and most things you do to attain certification end up saving money in the long run. We have been doing this in the organization for years and have seen energy reduction, which saves money. We have done cost studies that demonstrate a return on investment. â&#x20AC;&#x153;Although meeting the requirements for LEED certification can increase the budget up front, once your investment is recouped, the organization can reap the savings for years to come.â&#x20AC;?
Being flexible for the future As with all healthcare organizations, Geisinger is looking toward the future for flexibility, expansion needs, new technology, and what it all means for the organization. â&#x20AC;&#x153;We have consistently seen a demand for
NextGate Healthcare data exchange requires precise identification, linking, and management of patient and provider identities. NextGate MatchMetrix EMPI and enterprise registry solutions promote interoperability and reduce clinical and financial errors related to mismatches between health data and patients. HIEs and health organizations rely on NextGateâ&#x20AC;&#x2122;s 17 years of experience to provide accurate, affordable, user-friendly, and easily implemented data management solutions.
This new building increased the campus size by
more beds, a trend toward more high-tech equip-
about 50 percent. The building attained LEED silver
ment,â&#x20AC;? he said. â&#x20AC;&#x153;We have to ensure we have enough
certification and houses a level 2 trauma center.
electricity and the chilled-water capacity to provide
The project began in 2005 and ended in 2008 and
cooling. We have to be positioned to be quick and
came in $2 million under budget. Even President
nimble to deal with the changing technology.â&#x20AC;?
Obama praised Geisinger for its ability to provide quality, cost-effective care. Gladish attributes the organizationâ&#x20AC;&#x2122;s success to teamwork and communication. â&#x20AC;&#x153;People at the top and the bottom must understand each other,â&#x20AC;? he said. â&#x20AC;&#x153;In facilities, weâ&#x20AC;&#x2122;re in the middle. We need to understand what the
Gladish said itâ&#x20AC;&#x2122;s difficult to predict future space requirements because buildings must last for decades and hospital priorities can change in that time. Cardiology and oncology have grown in the past 20 years, while other specialties have become less prominent. Gladish said facilities design needs to plan for
executives are doing, and they need to understand
the proper space and be ahead of the curve, but at
our concerns. With a new building, itâ&#x20AC;&#x2122;s the same.
best they can plan for adequate utility capabilities
You establish a team and communicate. The people
and flexible space. Again, he stresses, communica-
at Geisinger do a good job of communicating what
tion of intent and openness is the key.
they are trying to accomplish.â&#x20AC;?
by Patricia Chaney
HCE EXCHANGE MAGAZINE Real Issues : Real Solutions
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09 | The Seton Healthcare Family
At Dell Children’s Medical Center, Seton has been
As organizations across the United States prepare themselves for the implementation of healthcare reform, one system in Central Texas is determined to lead the revolution in making healthcare less fragmented and more efficient for its patients.
it is collaborating with Children’s Medical Center in Dallas and UT Southwestern on introducing new services like echocardiography in congenital heart surgery. Thanks to its historic collaboration with the University of Texas, Seton’s involvement in clinicalresearch trials has expanded exponentially.
Already a leader in perinatal safety and pressure-ulcer prevention, The Seton Healthcare Family is pioneering many innovations and forming multiple partnerships that are laying a solid foundation for the future.
Seton’s ongoing partnership with the nursing programs at universities and colleges in the area continues to yield fruit. Seton hires approximately 200 RN residents per year through the 18 to 30week Seton RN Residency program. Each available slot typically attracts six to eight qualified appli-
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A history of leadership Seton was founded as the 40-bed Seton Infirmary in 1902 by the Daughters of Charity of St. Vincent de Paul. In 1975, Seton Medical Center (Austin) was built. Today, Seton serves 11 counties with a population of 1.9 million. A member of Ascension Health, the largest private charitable healthcare system in the United States, Seton is a fully integrated healthcaredelivery system and features the broadest range of services in Central Texas. Seton also offers the most diverse and wide-ranging services of any regional healthcare system in the United States. Seton is the largest Austin-based private employer in Central Texas with 12,000 associates and about 500 employed physicians. It provides a broad range of community services, including supplying the Austin Independent School District with all of its studenthealth services nurses. Seton is the largest safety-net provider in Central Texas, administering care for approximately 325,000 uninsured and underinsured patients.
the economy has created larger numbers of people
mitted itself to being a national leader in patient
Barnett chairs the Integrated Care Collaboration,
safety and innovation. Barnett said that it hasn’t
comprised of representatives from both public and
been an easy road, but the results are promising.
private organizations who provide care to the unin-
For example, Seton’s perinatal safety program has
sured and underinsured. The collaborative’s chief goal
earned national acclaim thanks to the adoption of
is to create a robust communication system that
evidence-based practices, such as restricting elec-
can provide a more coherent infrastructure for deliv-
tive inductions prior to 39-weeks gestation.
Also on Barnett’s radar is a coming population lion people over the next 10 years. In preparation,
Seton’s Asthma Management Pilot has resulted in
Seton is building a third bed tower for its pediatric
a 37-percent drop in emergency-department visits
facility, Dell Children’s Medical Center, at an urban
and a 63-percent decrease in hospital stays.
redevelopment site. It also constructed three new hospitals over a 36-month period during 2007 - 2009.
been greater. “We have seen an increase in individuals who come to us who don’t have anywhere else to turn as
light of the industry’s multiple paradigm shifts.
“We are finding that the demand for services con-
department visits and hospital stays among pa-
current healthcare-delivery system is its compart-
things besides adding beds to bring some additional
tients enrolled in the program by 33 percent and
mentalization and the degree to which that sort of
capacity online,” Barnett said.
75 percent, respectively. Seton number-crunchers
siloed mentality creates a more fragmented system,
estimate a $2.85 benefit for every dollar spent on
and individuals who are seeking healthcare services
the program.
experience care as fragmented,” he said, adding, “If
He added that this growth will demand a provision
Partners for the future
especially since the demand for services has never
education program for uninsured and underinsured
expand partnerships and collaborations, especially in
tinues to be pretty robust, but we will need to do other
Given its reputation, it would be easy for Seton
clinical environment in which its patients are served,
In its first year, Seton’ home-based diabetes
........
Caldwell County residents reduced emergency-
this demand is going to require more collaboration.
continues to work hard to improve the safety of the
successful pilot projects in partnership with local
boom. Central Texas is expected to grow by one mil-
Meeting increasing demands president and chief executive officer, said the system
Furthermore, Seton has rolled out two highly communities and donors. For children with asthma,
of service beyond what Seton already provides, and
to coast on past acclaim, but Charles J. Barnett,
During the past decade, Seton has also com-
who do not have any insurance,” Barnett said.
ering care.
200
cants, making this program highly competitive.
“What these two projects show is that, by taking
“I think one of the greatest weaknesses of the
we had a more cohesive delivery system, one that pro-
the time to visit with patients in their homes and
vided services and care across the full range of needs
offering specific tools such as written diets, exercise
of an individual, one that was more person-centric, we
Seton places a high priority on its numerous partner-
and medication plans, we are improving the qual-
could cut costs out of the system in a way that would
ships. For example, the organization has teamed with
ity of care and quality of life while reducing costs,”
benefit our community and our state, and I think that’s
Austin Regional Clinic, the largest multi-specialty
Barnett said.
true for the whole country.” by Pete Fernbaugh
working on clinical-translational research with The
An obligation to collaborate
University of Texas Southwestern Medical School and
Barnett believes that healthcare organizations are
the University of Texas System.
obligated to their patients and their communities to
group in Central Texas, on a number of initiatives, including making care less fragmented. Seton is also
, >d, Z & />/d/ ^
working on expanding its quaternary services, and
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The Seton Healthcare Family
HCE EXCHANGE MAGAZINE Real Issues : Real Solutions
37
10 | Greater Hazleton Health Alliance
Greater Hazleton Health Alliance In these days of one-stop shopping malls and gas stations where convenience and accessibility are at the tips of the consumer’s fingers, it is only inevitable that other service industries will follow suit, including healthcare organizations.
Jim Edwards, President & CEO
M& &T Bank. Understanding what’s ’ important.
Located in Hazleton, Pa., Greater Hazleton Health Alliance is angling to be a leader in this one-stop approach to healthcare. As Jim Edwards, president and CEO of Greater Hazleton, describes it, his organization is really “a one-stop facility for all your outpatient surgical and ancillary services,” a strategy that has proven effective for this small community hospital.
improving the quality of life in all the communities we serve. This commitment, coupled with innovative banking solutions, personal attention, and understanding our customers’ needs, has earned us a reputation as one of the strongest and most highly regarded regional banks in the country. And now that we’ve added the renowned wealth management and institutional expertise of Wilmington Trust, our customers can depend on us for more than ever before.
WE’RE PROUD OF THE RELATIONSHIP WE’VE DEVELOPED WITH JIM EDWARDS AND THE GREATER HAZLETON HEALTH ALLIANCE.
Competitive nationwide Greater Hazleton offers three basic areas of services—inpatient, outpatient, and rehabilitative services. At the 150-bed Hazleton General Hospital, such
mtb.com ©2011 M&T Bank. Member FDIC.
inpatient services as emergency, surgical, OB, acute rehab, and general acute are offered. Since May 2007, the Hazleton Health Wellness Center has offered outpatient services, featuring a surgery center, a fully equipped imaging center, and cardiac
M&T Bank
services including diagnostic testing, rehab, and a
these processes to allow us to be able to achieve at
community fitness center. Rehabilitative services are conducted on an outpatient basis and feature physical, occupational, aquatic, pediatric, speech, and lymphedema therapies. Additionally, Greater Hazleton’s musculoskeletal line features orthopedics, pain management, and sports medicine. For a fourth year in a row, HealthGrades named
primary-stroke center. With such progress in clini-
Greater Hazleton in the nation’s top five percent for
cal services, the organization has seen remarkable
patient safety and in the top 100 hospitals nation-
improvement in its patient satisfaction scores, and
wide for pulmonary care, an honor that is even more impressive given the high levels of pulmonary disease in the surrounding community. Greater Hazleton has also been designated as a
Edwards is quick to give most of the credit to his staff. “All the successes that we’ve been able to achieve certainly would have never happened had
Bariatric Surgery Center of Excellence and houses
we not had not only the support of the medical
northeastern Pennsylvania’s first accredited
staff, but the hard work that they’ve put into all
For more than 150 years, M&T Bank, has been known as one of the strongest banks in the nation. Helping businesses grow is one of our strengths. We serve businesses of all types with a complete range of financial products and services, and now that we’ve added the renowned wealth management expertise of Wilmington Trust, our customers can depend on us for more than ever before.
the level that we’re achieving,” he said.
The healthcare reform dilemma Because of Greater Hazleton’s top performance, Edwards feels that they are well-positioned for healthcare reform. However, he worries about adding a significant number of individuals to the rolls of the insured. “I think there’s a lot of pent-up demand for healthcare services amongst that population, and I guess my concern and something that I haven’t heard a lot of discussion about is, who’s going to provide that care?,” Edwards said. “We already have a shortage of physicians in this country right now and a
HCE EXCHANGE MAGAZINE Real Issues : Real Solutions
39
shortage of other healthcare givers such as qualified
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nurses and technicians. “If within a several year period of time, we’re
Delaware Valley Surgical Supply www.dvss.com
going to significantly add to those who are going to be seeking out healthcare services, that coverage is only as good as the ability of the providers to be able to provide the care. I’m concerned that you’re bringing all these people in, and I think it’s wonderful to
hospital, Edwards said the remarkable aspect to
provide them coverage, but I have not heard a lot of
telemedicine and technology in general is being
discussion about how that additional demand is go-
able to have access to these services in real time on
ing to be met. You don’t train doctors in two or three
a remote basis.
years or nurses or techs or other care providers.”
For example, Greater Hazleton established a
Edwards said that it’ll be eight to 12 years before
teleburn program with Lehigh Valley Hospital. This
any significant dent is put into this shortage. There-
enables them to assess burn patients when they
fore, physician recruitment continues to be an area
come into the hospital immediately, working with
in which he is devoting a great deal of energy and
a quaternary hospital like Lehigh to determine
financial resources. For instance, Greater Hazleton
what the most appropriate setting and care for that
has adopted a hospital-employment model for physi-
patient is. They’ve also established a stroke-alert
cians. Although the shortage is still there, this model
program with Lehigh Valley.
has helped them to improve the numbers in their
“These are areas that we’re providing a better
ranks.
level of care,” Edwards said. “Patients are getting
Into the future and beyond
better outcomes, and at the same time, it’s reduc-
Edwards said he has two primary goals for the
not going to see available at a small community
ing the cost of care. It’s typically things that you’re
future—gain accreditation as a chest pain center
hospital, but just because you don’t have a doc-
and become accredited as a Level III trauma center. Edwards said this is important because the nearest trauma center is 30 miles away, and there are many elderly people in his region with heart disease. “For us to be able to be accredited as a trauma center, to be able to provide those services that are currently needed in this community, and to be able to provide many of those services that people have to leave for now, to be able to do them right here in the Hazleton community, is a very exciting proposition for us,” he said. Greater Hazleton is also working on leveraging telemedicine services. Even though they don’t have enough volume to keep physicians in certain specialties busy on a full-time basis and even though they
tor sitting here on site doesn’t mean that you can’t
“Through the use of information technology, it’s allowing much greater access to communities such as ours. ”
have access to that type of clinical expertise.” He added, “Our belief is you shouldn’t have to live right next door to a Lehigh Valley Hospital or a Jefferson or UPMC to be able to get those types of services. Through the use of information technology, it’s allowing much greater access to communities such as ours. ” by Pete Fernbaugh
can’t provide the services of a tertiary or quaternary
HCE EXCHANGE MAGAZINE Real Issues : Real Solutions
41
11 | Lincolnwood Place
Growing slowly but surely Lincolnwood is growing and offering added services to its residents, but, as with all industries related
FOR THOSE WHO CARE
to the housing market, Lincolnwood is seeing a slowed growth rate in the independent- living side of the business. “The market for independent living is not picking up as fast as we would like to see,” Umanskiy said. “A lot of customers are unable to sell their homes, which prevents them from moving into our community.” Despite the slowed growth, Lincolnwood is remodeling their dining room, auditoriums, arts and crafts room, several apartments, and adding amenities throughout the community. The company installed an emergency-call system and distributed pendants to residents free of charge. Using these, independent-living residents can notify staff if there is anything unusual going on. The pendants work throughout the Lincolnwood campus.
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In addition to independent living, Lincolnwood also
Lincolnwood Place
has 25 assisted-living apartments and a five-star rated rehabilitation facility. Umanskiy said the rehabilitation center was recently redone with flatscreen televisions, an expanded therapy room, and
America has a continually expanding elderly population that is evaluating its future living arrangements. Continuum of Care Retirement Communities (CCRC) offers a great opportunity for the elderly population. They have choices of independentliving apartments that often have added security measures over regular apartments and options for increased assistance and medical care as needed.
Regina Umanskiy, Executive Director
Lincolnwood Place in Lincolnwood, Ill., is a 299-bed CCRC, offering independent-living apartments, assisted-living apartments, skilled nursing, rehabilitation, and therapy services. The community places a great emphasis on hospitality and community service. With 234 independent-living apartments, Lincolnwood is geared toward the newer population of elderly adults looking for a stable environment that feels like their own home. “Lincolnwood is a place for people to thrive and enjoy their golden years,” said Regina Umanskiy, executive director. “We have all levels of care, activities, transportation, and the best rehabilitation center in the area.”
added windows to increase natural light and promote healing while people receive therapy services. Lincolnwood has made a large investment in added security measures for assisted-living residents with the addition of GE QuietCare. QuietCare has motion sensors throughout the apartments that monitor residents’ behavior for about two weeks. After obtaining a baseline, the system will notify nurses through pagers if anything out of the ordinary happens in a resident’s room. Nurses will also get a page if someone stays in the bathroom for more than 15 minutes or other signs that there may be a problem.
HCE EXCHANGE MAGAZINE Real Issues : Real Solutions
43
“We share our expertise and give advice to help people stay healthy.” “The QuietCare system adds peace of mind for fam-
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ily members,” Umanskiy said. “By notifying us early of issues, the system helps prevent hospitalizations
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and maintain residents’ health.” Another feature for all residents that makes Lincolnwood a unique community is dining options.
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The community has a culinary team designing menus and creating fresh, healthy food choices. In
Mindful Nutrition A Subsidiary of Cynthia Chow & Associates, LLC (773) 539-9364 www.mindfulnutritionusa.com
addition, the community offers a Dining for Wellness program that provides nutritional information and educational programs focused on a particular age-related disease such as diabetes, arthritis, or hypertension. The program focuses on one disease for a month, bringing in physicians to give lectures and offering cooking demonstrations. It culminates in a gala dinner with specially prepared meals. The program also teaches residents how to prepare the meals themselves. Lincolnwood also offers a range of entertainment programs for residents including a Wii bowling team that competes with other local communities, an acting/film troupe, and intergenerational programs where local elementary school children visit to do projects with the residents.
For family members, seeing their loved ones in a
Lincolnwood exhibits this mission through its
dynamic environment is reassuring.
amenities, programs for residents, and devotion to
“They feel that we create a true family environment for our residents,” Umanskiy said. “We take
customer service and hospitality. The community continues to attract new
time to learn about our residents’ interests and
residents and is a place of choice for the city of Lin-
needs and then design programs and menus, for
colnwood. Umanskiy said the community partners
example, based on what the residents would like
with local hospitals to help them work on Medicare
to see.”
initiatives and implemented protocols to reduce
Part of the greater whole Lincolnwood is part of the Senior Lifestyle Corpora-
readmission rates. It also serves as a resource to senior centers, hospitals, and even condominiums. “We share our expertise and give advice to help
tion that has facilities throughout the nation. The
people stay healthy,” she said. “These activities
corporation’s mission statement is “We create op-
keep the community and its residents thriving.”
portunities to nurture the spirit of America’s elders and celebrate the rhythm of each life through open
by Patricia Chaney
communication, innovative leadership, personal growth and a commitment to excel.”
HCE EXCHANGE MAGAZINE Real Issues : Real Solutions
45
12 | Naval Hospital
Tightening the timeline The design team went to work and found innovative ways to speed up design elements and begin construction very quickly. The government team developed a robust bridging document that contained a fixed floor plan, layout, and exterior aesthetics, taking out uncertainty for the bidders. Contractors were given 30 days to review the RFP and make a proposal for the project. Clark Construction and McCarthy formed a joint venture to produce the successful proposal. HKS is serving as the architect and designer of record to ensure the success of the design-build procurement. These established companies, along with the government staff involved, established an experienced team to manage all aspects of the project. Clark/McCarthy and the government team mapped out a schedule for design reviews and early-site,
equipment, procurement, and construction activities to ensure the January 2014 deadline is met. “We have done process mapping so that we can hold people accountable to what they are asked to do and when,” said Cmdr. Whit Robinson, resident officer in charge of construction. “We immediately do a root-cause analysis to identify and correct bottlenecks. We have close coordination and colocation of players to facilitate the tight turnaround times for design packages.” Another way the team has sped up the process is by planning medical equipment into the facility design and then assigning the contractor to procure the equipment. Commander Robinson anticipates this will save time, money, and coordination. “We have streamlined the process of how we can deliver a hospital of this size in the amount of time given” said David Williams, project manager
Bishop, Inc. is honored to be a part of the state of the art Camp Pendleton Hospital Replacement Project.
Naval Hospital In December 2010, contractors broke ground on a new $394-million Naval Hospital at Marine Corps Base Camp Pendleton. Receiving funds from the American Recovery and Reinvestment Act (ARRA), the team has three-and-a-half years to complete what would typically be a seven-year construction project. The new facility is being built on a new 67-acre site near the main gate and will include a 500,000-square-foot hospital, a 500,000-square-foot parking structure and ancillary facilities including the central utilities plant.
We send our sincerest appreciation and gratitude to Clark Construction; whose hands on expertise helped us easily transition into the federal construction market. Their personalized approach with small business was not only getting to know our company, but also taking the time to know our staff. Clark Construction has valued our contributions and provided the tools that have helped us advance our success in the general construction industry . Bishop, Inc has built a solid reputation by fostering solid relationships that are the foundation of our business. From the time we began operations, our initial ambitions were to provide quality service at a competitive price while maintaining a safe work environment. Our team, with it’s multi-faceted experience is one of our greatest strengths; for they possess a wealth of knowledge from general construction, roofing, building inspection and industry specific sales and safety knowledge. Our dedication to safety, while keeping our projects on schedule, helped us achieve the STAR award from the Navy on one of our very first 8(a) government projects!
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Real Issues : Real Solutions
for design. “This streamlining has allowed us to
In addition, the project will meet LEED Gold stan-
go forward at this speed. We integrate all infor-
dards. There is clean-power generation, PV panels,
mation from the design side to the construction
green roofs, low-impact landscaping on-site and
side to make sure what we’re building is what we
solar hot water. Camp Pendleton also has high
planned.”
standards for low-impact development. The design
The designers are also using building information modeling (BIM), an interactive 3-D simulator
habitat. During the design, the team searched for
that helps designers find and fix space conflicts
endangered species in the area that might be af-
before they reach the construction phase.
fected by the project. This research led the team to
“Using BIM, our designers search for clashes
purchase 40 acres of mitigation land for an endan-
in the design, then we can have offices in different
gered bird species, and the new hospital will have a
geological locations collaborate to solve the prob-
vernal pool to support endangered shrimp.
lem,” Cmdr. Robinson said. “We plan to take these
During construction, the project has two bio-
models at the end of the project and deliver them to
monitors available and a resident archaeologist in
the final user so they can use it for facility mainte-
case anything is uncovered.
nance and repair.
Using evidence-based design and other standards
“We will have plaquards on site dedicated to those warriors. We are staying dedicated to the folks who give so much on a daily basis.”
incorporates ways to protect the surrounding
Even with the tight schedule and considerations for land, equipment, and design, the team never loses sight of what’s most important—the people for whom the hospital is being built. “The real stakes in this project are the wounded
The Naval Hospital Camp Pendleton Replace-
warriors, those who have given so much,” Cmdr.
ment Project is following evidence-based design to
Robinson said. “We will have plaquards on site ded-
increase throughput and promote healing through
icated to those warriors. We are staying dedicated
lighting, private rooms, design, and other elements
to the folks who give so much on a daily basis.”
commonly used. The team also looked at other military hospitals including the new Walter Reed
by Patricia Chaney
National Military Medical Center in Bethesda, Md., to compile lessons learned. The new hospital will be all electronic, using a fiber-optics network, an electronic health record that communicates with outlying clinics on and off-base.
HCE EXCHANGE MAGAZINE Real Issues : Real Solutions
49
13 | NCH Healthcare System
NCH Healthcare System Information technology touches all aspects of delivering healthcare these days, and like most areas, hospital IT departments are asked to do more with less money. As technology advances, more space is needed to house servers, cables, and other hardware, not to mention more staff to oversee the new technology. This creates challenges for any organization as they seek to cut costs and find a balance between budgets, clinical care, and technology.
Every four seconds, someone, somewhere in the world is helped by a Medtronic product.
NCH Healthcare System in Florida found a solution that may be a growing trend in healthcare â&#x20AC;&#x201C; outsourcing.
Susan B. Wolff, Vice President & CIO
(Editorâ&#x20AC;&#x2122;s note: As of Sept. 30, 2011, Ms. Wolff retired from her role as vice president and CIO of NCH Healthcare System.)
retained by Cerner. NCH helped employees who lost their jobs find new opportunities.
To learn more about Medtronicâ&#x20AC;&#x2122;s Spinal and Biologics Business, visit us at www.medtronic.com.
â&#x20AC;&#x153;The choice to outsource was a tough decision for all of us, but it was supported at the board level, and it has been a good decision for the organiza-
A difficult means to a quality end â&#x20AC;&#x153;In 2009, I was faced with needing to cut costs in
tion,â&#x20AC;? Wolff said. â&#x20AC;&#x153;We have increased stability and gained a deeper pool of talent to draw on. We have probably accomplished more in the past year than in any year prior.â&#x20AC;?
the midst of a higher demand for IT services,â&#x20AC;? said
Wolff said she is not sure if outsourcing is a
Susan Wolff, vice president and chief information
trend in healthcare IT, but it may be the best choice
officer . â&#x20AC;&#x153;Our infrastructure for our data center was
for some organizations, especially ones as large as
more than 20 years old and needed to be replaced.
NCH. The system consists of two acute-care hos-
Plus, our area of Florida attracts retirees, but not a
pitals totaling 680 beds and has recently acquired
lot of technical, qualified staff. We chose to out-
numerous physician practices. It has a group of 14
source our entire IT department.â&#x20AC;?
cardiologists and a multi-specialty group prac-
This was not an easy decision and required an
tice with about 50 providers. Excluding physician
extensive selection process. NCH chose Cerner as
groups, the system has about $400 million in an-
their vendor and was Cernerâ&#x20AC;&#x2122;s first client to out-
nual revenue.
source the complete IT solution. Since then, Cerner has seen more hospitals make the same decision. From an economic standpoint, NCHâ&#x20AC;&#x2122;s choice to
Leading the way in technology
outsource saved money and cut costs, Wolff said.
NCH has long been a leader in healthcare technol-
All hardware was migrated from the hospital to the
ogy. The system began using nursing documenta-
outsourcing company, eliminating the need for an
tion in 2001 and is now looking at tools that talk
upgraded data center. Furthermore, Cerner has a
to the medical record. Four years ago, the system
much larger pool of talent to draw from.
adopted a closed loop of medication administration
But, she added, the human element was the hardest part of the decision. The IT department had more than 65 employees, but only about 35 were
Š2011 Medtronic Sofamor Danek USA, Inc. All Rights Reserved. IRN11273-2.0-05/0910
(YH HU\ U\ 6HFRQGVV $G $G G B [ [ B LQ LQGG GG
$0 $0
â&#x20AC;&#x153;We have increased stability and gained a deeper pool of talent to draw on.â&#x20AC;?
using barcodes. Wolff sees the future of healthcare technology being in the ability of different devices to talk to the
HCE EXCHANGE MAGAZINE Real Issues : Real Solutions
51
INDUSTRY PARTNERS
“I think the role oF CIO is going to be more focused on getting people to collaborate.”
WL Gore and Associates, Inc. www.wlgore.com
In the future, Wolff believes that IT will remain an integral part of clinical care, requiring a new skill set for the chief information officer. “I think the role of CIO is going to be more focused on getting people to collaborate,” she said. “Medical staff, nurses, laboratory staff, they’re all interested in IT and have a certain level of expertise. The CIO will need to help everyone make the right decisions about what they’re going to do and provide support for those decisions.” by Patricia Chaney
medical record. NCH has hemodynamic monitors
heavily involved with the Institute for Healthcare
that record information directly into the patient’s
Improvement (IHI). Wolff said she noticed many
record, rather than a nurse manually entering the
presentations given at a recent IHI conference by
information. The system also recently purchased
NCH employees all cited IT as part of the qual-
infusion pumps that have a two-way communication
ity initiatives. The organization has already seen
with the record.
improvements in quality by using EMR rules to fire
Wolff said the excitement for innovation is found
alerts for various measures.
at all levels of the organization. The administra-
“We have used these tools to help comply with
tors, physicians, nurses, and other personnel at-
CMS core measures and other federal and state
tend conferences and come back with ideas of how
quality measures,” Wolff said. “We have lowered
they want to use technology.
our pressure-ulcer rate to close to 1 percent by us-
“We have a motivated group of people,” she
ing alerts. We have also won many quality awards.”
said. “More than 10 years ago, our philosophy was
NCH has qualified for Stage 1 of meaningful
that we were going to push for quality, and the rest
use and completed the attestation in September
will follow.”
of 2011. In 2009, NCH received recognition from
Technology has provided a great way for the hospital to improve quality. The organization is
HIMSS Analytics for achieving Level 6 of the EMR Adoption Model.
HCE EXCHANGE MAGAZINE Real Issues : Real Solutions
53
14 | Parkland Health & Hospital System
Established in 1957, Purdy-McGuire, Incorporated is a consulting engineering firm that offers a full range of Mechanical, Electrical, and Plumbing engineering and LEED Commissioning services. Purdy-McGuire has partnered with local and national architectural firms and other clients to produce quality projects in several categories including (but not limited to) educational, medical office, commercial, national retail, churches, government, master planning, energy modeling, feasibility studies, and garages/parking structures. The firm is registered to practice in most of the continental United States with 11 registered engineers and 8 LEED APs on staff. Purdy-McGuire is DBE, WBE & HUB Certified.
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Parkland Health & Hospital System “By our actions, we will define the standards of excellence for public academic health systems.”
Walter Jones, Jr, AIA, Senior Vice President of Facilities
“We received 82-percent approval for the bond is-
healing environment. Jones said the new facility
sue from Dallas County voters,” said Walter Jones,
will have 862 private adult rooms with private show-
Jr., AIA, senior vice president of facilities. “That is
ers in each room. Each room will have a dedicated
overwhelming support from the community for the
family area. The 96 beds in the neonatal intensive
value of our hospital. We appreciate that support
care unit will also be private.
That is the vision statement of Parkland Health & Hospital System, a healthcare system serving more than 2.3 million residents in Dallas County, Texas. Parkland hospital has 723 beds and about 55,000 annual admissions. It is the teaching hospital for the University of Texas Southwestern Medical Center and boasts 10 centers of excellence.
and try to show it in every activity we do. We are
“Accommodations for family in our existing
pledged more than $1 million toward the fundrais-
provide more space and comfort for family mem-
For nearly 10 years, the hospital has been evaluating strategies to achieve such a lofty vision, and in the fall of 2010, Parkland broke ground on a $1.27-billion, twomillion square-foot replacement facility.
ing campaign.
bers to stay with patients and be an active part of
To receive funding for the project, the hospital sought taxpayer support for a bond issue that would provide $747 million of the project’s funding.
Parkland and its contractors have been using
said these were the norm in the 1950s, but today’s
evidence-based design to create a patient-centered
privacy laws and patient expectations require more.
now working together to build an excellent facility
facility need improvement,” Jones said. “A lot of
that can provide the level of service and quality our
family shows up to be with patients. We believe that
institution is dedicated to.”
there is no better advocate for the patient than their
In addition, Parkland employees have
Using evidence-based design
family members. The design of our new facility will
their care.” The existing hospital has about 70 percent semi-private rooms and dormitory showers. Jones
HCE EXCHANGE MAGAZINE
55
Parkland evaluated retrofitting existing rooms to accommodate private showers, but it would reduce the bed count and square footage in rooms detrimentally. The hospital will also incorporate features that increase comfort and healing elements, including temperature control in rooms, large windows to allow for more natural light, and gardens and landscaping that are visible from most rooms. Jones said that approximately one-third of the land for the new facility is dedicated to landscaping. Slip-resistant flooring, no curbs on showers, and visible hand sanitizer throughout the facility are some ways in which the hospital will improve
be new and how much should be transferring what
“The existing facility is undersized and overcrowd-
we have.”
ed,” Jones said. “What needs to be done in this
The new Parkland will incorporate sustainability
patient safety. Noise control is another evidence-
features and flexibility with the intention of lasting
based design element being incorporated.
50 to 100 years. Jones said the hospital is on track
Staff will have separate elevators, card access to staff areas, decentralized workstations, and wireless capability to provide a higher level of care.
an advanced facility that will enable it to provide quality care and achieve its mission of superior
“We are trying not to build a facility that is
charting, and ordering can take place in patient
in place today,” Jones said. “We are looking for the
rooms or workrooms.
best we can find today and remaining flexible to
meet the needs of patients and best practices as seen from the patients’ eyes.
Sustainability and flexibility
adapt to what might come.”
Managing the transition period Keeping such a large project on track and within budget is a huge feat for any hospital. To keep all contractors and consultants involved, Parkland has
Building a replacement facility is a balancing act
brought the primary contractors and consultants on
in incorporating new technology, purchasing new
site for the duration of the project. They are work-
equipment, choosing what equipment to carry over
ing in the existing facility in a collaborative environ-
from the previous facility, and planning for future
ment. Jones touts the advantages of this model
technological advances.
because he believes it develops an understanding
“A major component of this project is deciding how much to buy,” Jones said. “The new facility is double the size of our existing hospital. We are add-
Despite challenges, Parkland is on track to have
points away from LEED Gold. limited by our thinking or determined only by what’s
ily advisory committee to ensure the design choices
ing a more intense question.”
to achieve LEED Silver status and is a handful of
Jones said the floors are designed so clinical care,
The design team meets with a patient and fam-
facility to continue to deliver quality care is becom-
medical service. by Patricia Chaney
INDUSTRY PARTNERS ARS Engineers, Inc. www.arsengineers.com DATUM Engineers, Inc. www.datumengineers.com
among disciplines and keeps conflicts at a minimum. During the construction, which is scheduled to
ing more operating rooms, expanding the emer-
be completed in 2014, Parkland is also faced with
gency room, and growing our imaging department.
difficult decisions about how best to provide care in
We are determining how much equipment should
the existing facility and what investments to make.
HCE EXCHANGE MAGAZINE Real Issues : Real Solutions
57
15 | St. Rita’s Medical Center
One initiative raised awareness of the nutritional value of meal choices through a color-coding system and by posting the calories in each option. Reber said the sale of french fries declined 10 percent in just 30 days. Furthermore, all vending machines will have healthy choices. With a large set of the nation’s population uninsured or underinsured and a declining general state of health compounded by the country facing a physician shortage, the need for improved community health is paramount. Given these factors, Reber said it’s possible “we may not have the resources to provide care at the scope and level we historically have.”
Involving patients in care One area St. Rita’s has been working on is its com-
“We are working to establish communitywide protocols, evidence-based pathways in place for five major chronic diseases,”
munity population health management, specifically for diabetes. The organization is working to create
access their individual health records. At that site,
a shift from looking at a diabetic admission not as
they can view test results, request appointments,
one single admission, but as a person that needs
and overall, be more involved in their health.”
to be managed across the health system. St. Rita’s
St. Rita’s Medical Center Looking at the changing healthcare landscape, one shift in many communities is toward providing more community health management services. As Jim Reber, chief executive officer of St. Rita’s Medical Center puts it, in the future the hospital may become more of a “genuine health system with health offerings rather than illness offerings.” St. Rita’s Medical Center, in west-central Ohio, is making an organizational shift toward health offerings through community partnerships and employee initiatives. Jim Reber, CEO
“We are working to establish community-wide protocols, evidence-based pathways in place for five major chronic diseases,” Reber said. These five major chronic diseases are hypertension, coronary-artery disease, congestive heart failure, joint degeneration, and obesity.
Additionally, Reber said, an iPhone app is in
has specialists and primary-care providers working
final testing. Through this and other vehicles, he
together throughout the community to help prevent
hopes to further facilitate the activation of patients
those admissions.
and their increased involvement in care across the
Historically, patients have been seen at [somewhat] infrequent intervals by their primary-care
St. Rita’s system.
having a process where patients are kept in closer
Maintaining St. Rita’s economic health
contact with their health team, the teaching and
As it focuses on the health of the community it
education becomes a continuous process and
serves, St. Rita’s is also making strides to improve
patients can be helped much sooner, thus avoid-
the economic health of the organization, ensuring
ing readmissions. Perhaps the most critical part
its ability to continue providing high-quality care to
of managing a patient with diabetes (or any chronic
its patients.
physicians or during a hospital admission. By
illness) is understanding their lifestyle and the best approach in helping them achieve their goals.
St. Rita’s is a health-delivery system of about 13 entities and partnerships and is part of Catholic
“With declining reimbursement rates, there will
Healthcare Partners. It serves a 10-county region
be a need to improve patient health, patient involve-
in mostly rural Ohio, about two hours from major
ment, and compliance,” Reber said. “The next five
metropolitan areas. The system has about 3900
years will call us to be better at managing diabetes,
employees and $400 million in annual revenue.
asthma, heart disease, and other chronic conditions
Reber said the hospital has seen market-share
long before the patient is admitted to the hospital.
gains consistently for the past 10 years and has
“Our employed physician offices are using an elec-
maintained an alliance with five local hospital for 15
tronic system that contains a portal for patients to
years to share resources.
“We are also working with employees to see what motivates change, particularly in the cafeteria,” he added. HCE EXCHANGE MAGAZINE
59
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In a rural region, recruiting physicians and spe-
â&#x20AC;&#x153;On a cost side, we use lean techniques to help the
cialists is often difficult. St. Ritaâ&#x20AC;&#x2122;s has a physician-
organization, but we never allow that to undermine
employment model that has allowed it to recruit
patient or employee satisfaction,â&#x20AC;? Reber said. â&#x20AC;&#x153;We
specialists that are often hard to attract. However,
are looking at a greater level of accountability and
the organization believes that specialists want to
ways to eliminate waste. We think Epic will help.
congregate in metropolitan areas.
Patients will be able to go online and pick their own
â&#x20AC;&#x153;Recognizing this need and related market conditions complements our recruiting effort,â&#x20AC;? Reber said. â&#x20AC;&#x153;We think physicians want to assemble
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appointments, look at labs online, and other tools that empower patients.â&#x20AC;? With any initiative, Reber said, the focus of
in more stable call groups, leverage practice costs,
St. Ritaâ&#x20AC;&#x2122;s is always on doing what is best for the
and build collaborative relationships with like
patients and community it serves. As CEO for 23
and accretive specialties. Once a critical mass of
years, Reber is personally invested in improving the
,70(17
specialists is reached in the metro area, it becomes
lives of the organizationâ&#x20AC;&#x2122;s surrounding community.
more feasible for the group to then hub-and-spoke
He also advises that the key to a successful
$%,/,7<
out to rural areas and thereby meet patient demand
healthcare organization is to be driven by evidence,
in their local market and at their local hospital.â&#x20AC;?
not politics. All too often, the loudest voice or
3 &200
$7,21
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Improvement through lean To improve safety and efficiency, St. Ritaâ&#x20AC;&#x2122;s has im-
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the highest-ranking voice can dominate decisionmaking. â&#x20AC;&#x153;We believe that the best idea which improves
plemented lean techniques, including walk-arounds
the lives of the people in west-central Ohio should
and a reporting model where employees can go on
always be chosen.â&#x20AC;?
their computer and report anything that happened that they didnâ&#x20AC;&#x2122;t think was right. Reber said every
by Patricia Chaney
event reported is addressed and resolved within two weeks. The organization also plans to implement a full install of the Epic suite of products.
HCE EXCHANGE MAGAZINE Real Issues : Real Solutions
61
16 | United Health Centers of the San Joaquin Valley
Â&#x2021;Â?Â?Â&#x2039;Â&#x2022; Â&#x2021;Â&#x2021; Â?Â&#x2022;Â&#x2014;Â&#x201D;Â&#x192;Â?Â&#x2026;Â&#x2021; Â&#x2021;Â&#x201D;Â&#x2DC;Â&#x2039;Â&#x2026;Â&#x2021;Â&#x2022; Individual Attention. Group Benefit.
The UHC clinics offer general and family-medicine
UHC has implemented an electronic health record
services, general dentistry, laboratory, X-rays,
(EHR) and has formed a network with five other
preventive-medicine programs, behavioral health,
health centers to implement an EHR for 250 pro-
womenâ&#x20AC;&#x2122;s and childrenâ&#x20AC;&#x2122;s health and in-house phar-
viders across the clinics. The network received a
macies.
$3-million grant to pursue the opportunity, and
â&#x20AC;&#x153;We want our patients to feel like they always
ple for other networks that have followed outside
Colleen Curtis. â&#x20AC;&#x153;These are people who need ser-
the Central Valley area.
here and be treated like family.â&#x20AC;?
Community outreach and support UHC, through partnerships and tracking initiatives, is heavily involved in improving the health of the
As with many healthcare systems, UHC is looking at ways to improve the management of chronic diseases and keep patients out of the hospital. Curtis said the clinics are developing databases to
CVHN Group Disability Group Life Voluntary Life
Â?Â&#x2026;Â&#x201D;Â&#x2021;Â&#x192;Â&#x2022;Â&#x2021; Â&#x203A;Â&#x2018;Â&#x2014;Â&#x201D; Â&#x201E;Â&#x2021;Â?Â&#x2021;Ď&#x201D;Â&#x2039;Â&#x2013;Â&#x2022; Â&#x192;Â?Â&#x2020; Â&#x2020;Â&#x2021;Â&#x2026;Â&#x201D;Â&#x2021;Â&#x192;Â&#x2022;Â&#x2021; Â&#x203A;Â&#x2018;Â&#x2014;Â&#x201D; Â&#x2026;Â&#x2018;Â&#x2022;Â&#x2013;Â&#x2022; Â&#x2122;Â&#x160;Â&#x2039;Â&#x17D;Â&#x2021; Â&#x203A;Â&#x2018;Â&#x2014; Â&#x2022;Â&#x2014;Â&#x2019;Â&#x2019;Â&#x2018;Â&#x201D;Â&#x2013; Â&#x2018;Â&#x2014;Â&#x201D; Â&#x192;Â&#x2022;Â&#x2022;Â&#x2018;Â&#x2026;Â&#x2039;Â&#x192;Â&#x2013;Â&#x2039;Â&#x2018;Â?Ǥ
track outcomes for patients and implement best practices. One initiative, ongoing since 2000, has tracked
community it serves. UHC is one of 12 community
about 3,000 patients with diabetes. Initially, the
health centers in the Central Valley Health Net-
project saw A1C measures come down below the
work. Members of the network have similar patient
national average, and Curtis cites the tracking ef-
populations and familiar characteristics across a
forts as a reason for that improvement. The next
17-county region.
step in managing these patients is using an EHR to exchange information with hospitals and help prevent admissions by adequately managing complica-
United Health Centers of the San Joaquin Valley
Â&#x2022;Â&#x2018;Â&#x17D;Â&#x2014;Â&#x2013;Â&#x2039;Â&#x2018;Â?Â&#x2022;
Curtis says this model has been an excellent exam-
have a place to go,â&#x20AC;? said Chief Executive Officer vices and have nowhere else to go. They can come
Â?Â&#x2022;Â&#x2014;Â&#x201D;Â&#x192;Â?Â&#x2026;Â&#x2021;
Employee Benefits Specialists
Contact Dennis Lee
4688 W. Jennifer Ave. Suite 103 Fresno 93722 559-275-7705 dennis@leeinsuranceco.com
leeinsuranceco.com
tions related to diabetes. With the wealth of services UHC offers, it is also important to ensure patients have access to these services. Being located in an area of migrant workers and high unemployment, UHC provides trans-
In the midst of budget cuts and healthcare reform, one group of clinics in California is growing in its commitment to care for a rural, migrant population. United Health Centers of the San Joaquin Valley is dedicated to managing a population often overlooked or one that doesnâ&#x20AC;&#x2122;t usually seek out care by providing â&#x20AC;&#x153;comprehensive medical, dental and community health services to the medically underserved.â&#x20AC;?
Colleen Curtis, CEO
United Health Centers (UHC), which celebrated its 40th anniversary in 2011, is comprised of seven medical clinics and six dental clinics around Fresno County. It also includes a host of Women, Infants and Children (WIC) clinics. In all, the clinics see about 200,000 patient visits per year, with about 80 percent Spanishspeaking patients. Most patients are migrant farmworkers, some local and some who live in the area only during the peak harvesting seasons.
portation services as well as assistance with social
organization. Around 2009, the centers lost about
services. Curtis said the center collaborates with
$2 million in State funding because of budget cuts,
the Central California Hispanic Chamber of Com-
but some fortuitous federal grant opportunities
merce on community projects, including mobile
appeared at the same time, allowing the centers to
vans that travel the community to let people know
continue their expansion efforts.
about healthcare services, where to find employ-
â&#x20AC;&#x153;The budget cuts were quite a hurdle to get
ment, how to apply for social services, and other
over,â&#x20AC;? Curtis said. â&#x20AC;&#x153;We had to become more ef-
needs.
ficient, have some cutbacks, but also continue our
Expanding facilities and services Over the past few years, UHC has seen drastic budget cuts as well as significant growth in the
expansion efforts. At the same time as the cuts, once-in-a-lifetime grant opportunities came about that required us to move quickly.â&#x20AC;? One grant came from the American Recovery and Reinvestment Act that provided $1.5 million
HCE EXCHANGE MAGAZINE
63
INDUSTRY PARTNERS
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said. “They receive diagnoses from specialists and can provide treatment options the next time they see these outbreaks.” Throughout adding services and expanding facilities, UHC has remained strong and acquired little debt. Curtis looks toward the future of providing the best care for patients through recruiting new providers. “The patient population is expected to grow, and UHC will build facilities to ensure we have the capacity to provide medical and dental services for those patients,” Curtis said. “We want to be that medical home where patients get all their needs taken care of. We are moving toward that vision one step at a time.”
/DERUDWRU\ &RUSRUDWLRQ RI $PHULFD +ROGLQJV $OO ULJKWV UHVHUYHG
by Patricia Chaney
toward a $4.5-million administration-building and
dentists. The new clinic will include WIC and offer
dental-clinic project. The new 4,000-square-foot
behavioral-health services.
dental clinic opened in June and replaced the previous 1,500-square-foot facility.
“Since 2001, we have made a huge investment in our facilities,” Curtis said. “We take great pride
Through an Affordable Care Act - Capital
in what our facilities look like so that our providers
Development Grant, UHC received $7 million to
feel good about treating patients, and our patients
upgrade the Parlier Clinic and build a new medical
can come to a beautiful facility that they deserve
and dental facility in Mendota, Calif. This included
and would rival any in the nation.”
remodeling the old clinic and moving dental and
In addition to clinic expansion, UHC also has
administrative services into a new administrative
expanded services to include dermatology tele-
building. The remodeled clinic then allowed for an
medicine. Working with the University of California
expanded pharmacy, 27 exam rooms, and space for
- Davis and the University of California San Fran-
nine physicians. That campus re-opened in Sep-
cisco, many patients have already been seen and
tember 2011.
diagnosed at a UHC clinic with a specialist providing
A third project in progress is remodeling and
the plan of care.
expanding a clinic in Mendota to include 12,000 square feet for eight medical providers and three
“Telemedicine is a great service for our patients and an education tool for our providers,” Curtis
HCE EXCHANGE MAGAZINE Real Issues : Real Solutions
65
17 | Cookeville Regional Medical Center
Nihon Kohden America
Cookeville Regional Medical Center At a time when medical facilities are merging or forming joint ventures and other partnerships, few regional hospitals still stand on their own. Cookeville Regional Medical Center in Cookeville, Tenn., is a 247-bed acute-care medical facility serving a 14-county area in the Upper Cumberland region. The hospital is situated in a primarily rural area about 90 minutes from the major metropolitan areas of Nashville and Knoxville.
Nihon Kohden America congratulates Cookeville Regional Medical Center for being an early adopter of a Defensive Monitoring strategy with the Prefense™ Early Detection and Notification System™. Prefense alerts clinicians at the first sign of patient deterioration on traditionally unmonitored Med/Surg units, enabling quicker interventions to prevent in-hospital complications and safeguard patients against medical harm.
Growth in uncertain times A large percentage of Cookeville’s patients are on Medicare or TennCare, and the hospital has to contend with high amounts of bad debt. Dr. Menachem Langer, chief executive officer, said the average household income in most of the surrounding counties is $30,000. Add to that, the hospital is surrounded by private hospitals and urgent-care centers that do not accept Medicaid, sending most of those patients to Cookeville’s emergency department. Despite these challenges, Cookeville has seen tremendous growth over the past few years and maintains a higher standard of care than many large, tertiary care centers. Cookeville has many services not commonly found in community
Dr. Menachem Langer, CEO
hospitals, including cardiac surgery, neurosurgery, and a cancer center.
HCE EXCHANGE MAGAZINE Real Issues : Real Solutions
67
“We have worked hard to change that perception and create that confidence in the community.”
practice average of 90 minutes. This is an excellent achievement for a community hospital transporting patients from rural areas and calling in doctors. Ambulances have EKGs to transmit data to the hospital, and patients bypass the emergency department and head straight to the cath lab. This focus on quality has served Cookeville well. In 2011, the hospital received numerous HealthGrades awards, including number one in Tennessee for coronary interventional procedures for the second consecutive year. The hospital was also ranked number one in Tennessee for overall cardiac care, vascular surgery, spine surgery, and orthopedic services. In addition, the hospital was ranked as one of America’s 100 Best Hospitals in coronary interventional procedures, orthopedic surgery, and spine surgery. The hospital also has numerous five-star rated programs and many programs ranked in the top 10 percent in the nation. Looking toward the next few years, Langer is
expanding services the hospital offers.
realistic about Cookeville’s future with its payer mix
“We are one of few hospitals to have growth despite
“We have to bring the medical staff along with the
and lowering reimbursements. He envisions the
changes and to be experiencing increasing inpatient
changes happening,” Langer said. “In the past, the
hospital moving toward acquisitions, mergers, or
admissions,” Langer said. “We have the capital to
hospital has been somewhat of a slower-paced com-
joint ventures.
reinvest back into the organization.”
munity hospital, but it now functions similar to a
Over the past three years, Cookeville has added
tertiary-care facility.”
“I recognize that we may not always be able to stand alone,” he said. “We are independent with no money from the city, and we will need to start
an $80-million patient tower, a $20-million operat-
Cookeville has made a push to develop a mis-
ing room expansion, a $5-million electrophysiology
sion and vision and create five pillars that support the
evaluating other opportunities for growth and
lab, and is currently working on an emergency-
mission and vision with a focus on quality. Langer and
expansion. But we will continue the same quality of
room expansion. The hospital is also rolling out an
other leadership have worked on ways to translate
care. We are proud that our communities feel they
inpatient electronic medical records system and
these pillars into measurable goals for staff and to
can get quality care in town. Ten years ago, people
computerized physician order entry in the first part
help the medical staff see how each of their actions
felt they needed to travel to Vanderbilt to get care.
of 2012. It is already halfway through rolling out
affects the organization.
We have worked hard to change that perception and
the EMR in outpatient and is on target to achieve meaningful use.
“We work on how the mission and vision relates to the staff level,” Langer said. “When staff talks about
Award-winning quality care
core measures, we have created score cards to help
by Patricia Chaney
nurses understand how their actions relate back to the organization. We relate everything back to quality.”
With Langer at the helm, Cookevillle has been working on a culture change to keep pace with the
create that confidence in the community.”
The hospital has greatly lowered door-to-balloon times, averaging 40 or 50 minutes, well below the best HCE EXCHANGE MAGAZINE
Real Issues : Real Solutions
69
18 | Gothenburg Memorial Hospital acknowledgment that there were other long-term
â&#x20AC;&#x153;Weâ&#x20AC;&#x2122;re at a time right now with the electronic
health facilities in the community and a recognition
health record where everybody on the planet is
of the gradual decline of long-term care.
pushing it and meeting the meaningful use stan-
To replace it, Gothenburg demolished part of the structure to build an 18,000-sq.-ft. physician
slower than most people simply because there
clinic onto the hospital as a way of preparing for the
are 500 companies out there trying to sell you 500
future when many of the primary-care physicians
different products, none of which will communicate
may fall under the same net or bundling / payment
with each other.â&#x20AC;?
process. This project is scheduled to be completed around Dec. 30, 2011. Gothenburg also houses one of only six certified
Steady as she goes
dard,â&#x20AC;? Johnson said. â&#x20AC;&#x153;Iâ&#x20AC;&#x2122;m going probably a lot
Johnson said he knows quite a few people who have spent a ton of money on systems that have ended up being failures. Common sense, he says,
cardiac-rehab units in the state of Nebraska. It was
means not rushing into a decision. So right now, he
also one of the first hospitals to put in a 16-slice
and Gothenburg are examining systems carefully,
CAT scan and one of the first to have high-definition
waiting to decide on the right one for their hospital
equipment in the OR both in the orthopedics and
and not worrying about meaningful useâ&#x20AC;&#x2122;s deadlines.
general-surgery areas. Another feature of Johnsonâ&#x20AC;&#x2122;s leadership is the
â&#x20AC;&#x153;The timelines for meaningful use, honestly, really donâ&#x20AC;&#x2122;t mean much to me because being in a
Johnsonâ&#x20AC;&#x2122;s approach to leadership over his 13 years
hospitalâ&#x20AC;&#x2122;s ability to make swift decisions. A few
small community, we may not have all of the funds
as CEO is even, both in temperament and handling.
years ago one of the major hospitals in the region
available that a lot of other places do,â&#x20AC;? he said.
On one side, he employs common sense and logic,
was doing a study about adopting an interstim-
â&#x20AC;&#x153;Weâ&#x20AC;&#x2122;ve been very successful here, but we certainly
and on the other side, he practices honesty and
transplant program through urology. They were
donâ&#x20AC;&#x2122;t make a practice of just going out and flush-
trust.
told it would take about six weeks of study to de-
ing money down the toilet, so to speak, just so we
termine whether they could do it. Gothenburg was
can meet a mysterious deadline that the federal
made, and in many peopleâ&#x20AC;&#x2122;s books they may think of
interested in adopting a similar program and took
government has put in place.
this as kind of a corny outlook, I really honestly do
all of one day to realize that they could do it and
look at whatâ&#x20AC;&#x2122;s in the best interests of the patients,â&#x20AC;?
thus became one of only two hospitals that offers
ist in this point in time, and you read it all the time
he said. â&#x20AC;&#x153;What can we do to meet their needs?
these procedures in the state of Nebraska.
from CMS, they come out with things that they call
â&#x20AC;&#x153;Whenever difficult, tough decisions need to be
Thatâ&#x20AC;&#x2122;s why they come to hospitals and healthcare facilities.â&#x20AC;? He described Gothenburg as fluid in what they
Clouds of reform For all of his clarity, recent federal measures can
â&#x20AC;&#x153;Probably one of the biggest oxymorons that ex-
final rule. So itâ&#x20AC;&#x2122;s kind of a silly season for a lot of those politically governmental-group programs.â&#x20AC;?
get in the way of Johnsonâ&#x20AC;&#x2122;s approach. He described
they decided to eliminate the 37-bed nursing home
deciphering healthcare reform as being akin to
new hologic digital mammography system, fund-
that was attached to the hospital. This was both an
wandering through a cloud.
ing this project through the Helmsley Charitable
In the last year, Gothenburg has purchased a
Trust foundation. Theyâ&#x20AC;&#x2122;ve also renovated the HVA systems throughout the facility and installed a new rehab center that offers physical, occupational, and speech therapy in their wellness building. â&#x20AC;&#x153;When you live in a rural area, if you have good facilities, good equipment, and good people, it
Itâ&#x20AC;&#x2122;s easy for healthcare organizations to be overwhelmed by the many requirements the federal government has enacted in recent years, especially if the organization happens to be smaller and possibly, rural. However, John H. Johnson, CEO of the 12-bed Gothenburg Memorial Hospital in the town of Gothenburg, Neb. (population 3700), does not let the changing climate affect his leadership, and he applies an age-old technique to cutting through all of the panicked chatterâ&#x20AC;&#x201D;common sense.
John H. Johnson, CEO
This approach seems to have worked. In 2011, the University of North Carolina did a study through the National Office of Rural Health and found that for the past three years, Gothenburg ranked in the top 32 critical-access hospitals in the United States.
We sell and service quality equipment such as Hologic, Agfa, Shimadzu, and Novarad. We are proud to be a partner with one of the top 100 critical access hospitals in the country, Gothenburg Memorial Hospital.
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their interim final rules. Never heard of an interim
do, trying to stay ahead of the curve, such as when
Gothenburg Memorial Hospital
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certainly makes recruitment of trained professionals a lot easier also,â&#x20AC;? Johnson said. â&#x20AC;&#x153;And we strive for those things. I do. Thatâ&#x20AC;&#x2122;s my work ethic. People want to be part of a successful organization, and itâ&#x20AC;&#x2122;s probably been our strongest asset.â&#x20AC;?
Remembering the patient As Gothenburg goes into the future, Johnsonâ&#x20AC;&#x2122;s rallying cry could be described as, â&#x20AC;&#x153;The patient always comes first.â&#x20AC;? At all times, he returns to this theme. Perhaps that is why he doesnâ&#x20AC;&#x2122;t get rattled when the government produces its latest standards and reforms. Most of those changes, he asserts, donâ&#x20AC;&#x2122;t even begin where new programs should start---at the patientâ&#x20AC;&#x2122;s bedside. â&#x20AC;&#x153;If the federal government ever wants to do something right, instead of dealing with a bunch of actuaries and geniuses and academics and things like that,â&#x20AC;? Johnson said, â&#x20AC;&#x153;someday maybe theyâ&#x20AC;&#x2122;ll speak with some of the people that actually do healthcare for a living and are closely in touch with it, and they might do something to change some of the tort reforms to eliminate frivolous lawsuits.â&#x20AC;? by Pete Fernbaugh
HCE EXCHANGE MAGAZINE
71
19 | Coastal Family Health Center
Providing the best care to residents in need Coastal Health provides a range of services to all of its area’s residents. It is committed not only to providing quality care that is accessible to everyone, but its mission is to provide access for individuals with common barriers such as lack of insurance, language, and transportation. Coastal offers internal medicine, pediatrics, women’s health, dental care, optometry, and mental health services, as well as HIV care, homeless care, labs, and an in-house pharmacy. In addition to clinical services, the center has a range of social services to help patients receive the care they need. “We see all vulnerable populations and offer transportation services, WIC, and translators,”
Coastal Family Health Center
Greer said. Coastal Family provides discounts to patients based on income and household size. The center also offers deeply discounted prescription medica-
Throughout the healthcare industry, the role of a chief executive officer is changing to become more transparent, to provide open communication with all levels of staff, to have a more decentralized decision-making system, and to be more involved in the community. In light of impending reform, community involvement and partnerships with various providers and specialties is viewed as the future for all healthcare providers.
Angel Greer, CEO
Coastal Family Health Center is a network of nine clinics and three mobile healthcare units along the southern coast of Mississippi. Coastal Family Health primarily serves populations in need and has been an important member of its community for more than 30 years. The center’s mission is to “serve our patients and contribute to building stronger and healthier communities in Mississippi.”
tions through its 340B in-house pharmacy.
Making technology a priority
implemented at some stage and are poised to benefit from meaningful-use incentives provided by the Centers for Medicare and Medicaid Services.
within the state to an electronic medical record.
Overcoming obstacles and planning for the future
As a dedicated part of the community, Coastal
As with all healthcare organizations, Coastal also
Greer said another goal in planning for the future of community health centers is to upgrade all centers
Family is spearheading the state’s Mississippi
suffers from budget cuts and lowered reimburse-
Health Safe Net, the Health Center Controlled
ments. Greer said the center is analyzing every
Network (HCCN). The partnership is comprised
stage of the healthcare delivery process to deter-
of 14 member community health centers working
mine areas of improvement and ways to manage
Chief Executive Officer Angel Greer said at times there can be a misconception in the private sector as to what it means to be a community health center. Coastal Family Health is known as a Federally Qualified Health Center, a nonprofit center that provides primary care in areas where care is needed but in short supply. While it is not a free clinic, Coastal Family Health Center works cooperatively with area free clinics to ensure a continuum of care for individuals experiencing extreme financial hardship.
together to implement electronic health records at
costs and improve reimbursement. The most recent
each and working toward achieving meaningful use
analysis involved performing a coding audit that
through the tracking of patient population health.
revealed some areas of improvement which when
“We receive some funding from the state and federal government and grants, but we are not 100 percent funded by these sources,” Greer said. “We offer affordable, quality care, but not free care. We are expected to operate as a business.”
Grant funding for the HCCN ends in 2012, and the
Coastal Family has a strong history of providing quality care. As a community health center, it has always had to meet certain standards and report quality measures to federal and state associations. As this becomes the norm for other facilities, Greer said she is “glad to see the push in all healthcare organizations to report measures and improve the quality of care.”
Additionally, the HCCN seeks to offer the network data hosting and back up for data protection. HCCN is working to develop a plan to sustain the work and support its current members. Greer said all facilities will have an electronic health record
corrected will result in improved claim-processing efficiency. Another challenge is recruiting talent to the area. “We have already experienced a physician shortage, and it is difficult to recruit physicians who
HCE EXCHANGE MAGAZINE
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are willing to come to rural areas to meet the needs of patients who are often without resources,” Greer said. “New physicians are searching for the most dollars and fail to consider the benefits of employment with a community health center. Coastal is a National Health Service Corps Site of Excellence. Physicians and other healthcare providers who serve in these centers can have their student debt lowered or forgiven. That is comparable to handing someone the amount of their student debt tax-free.” Despite these challenges, the health center is looking toward the future and ways to continu-
Larkin Community Hospital
ally improve care to the community. Coastal is planning to build a pediatric center that should be completed in late 2012. The center also works diligently to partner with community agencies and
Being surrounded by large tertiary-care hospitals would be a challenge for many community hospitals. Larkin Community Hospital in South Miami, however, not only has a thriving patient base, but is also performing better than many of its competitors in embracing innovation and benefiting from several healthcare reform initiatives.
other healthcare providers in the area to ensure patient access to other resources. “The additional benefit is that we are able to avoid duplication of effort,” Greer said. It’s this attention to quality and belief in Coastal’s mission that propels Greer’s optimism for the future. “As we move forward, it’s important to remain transparent and share information across the or-
Sandy Sosa-Guerrero, CEO
ganization,” Greer said. “As we consider the chal-
“We provide excellent clinical care,” Sandy Sosa-Guerrero, CEO, said. “Our patients come here because we are able to provide comprehensive care with an emphasis on coordination of care throughout the continuum of care. We value working with our physicians and community partners to ensure that patients receive evidence-based recommended care in a safe and comfortable environment.”
lenges and opportunities that lie ahead, I pull in expertise from various areas to help prepare for the future. Providing healthcare from a missiondriven perspective is challenging in these tough
Focus on innovation
economic and political times, but in my mind, it is
Larkin is a 142-bed acute-care hospital offering
the best way. This is my passion, one that I share
medical and surgical services in addition to com-
with many others throughout the country.”
prehensive outpatient, rehabilitation, and diagnostic services. Larkin has remained financially sound and
by Patricia Chaney
has consistently been ranked as one of the most cost-effective healthcare providers in South Florida. Most recently, the facility has added a state-ofthe-art PET CT and angiography unit in the main hospital building. Larkin has also made a $10-million investment in a new neurosurgery center that will contain the most advanced radiosurgical capa-
bilities, especially with the installation of a Eleckta Gamma knife unit, along with the latest MRI and PET CT technology. This state-of-the-art facility has been designed utilizing the most advanced technique in healthcare design to facilitate patient flow and care efficiencies. It will be headed by world-renowned neurosurgeon Dr. Aizik L. Wolf who treats patients from all over the United States, Latin America, and Europe. His extensive skill and expertise in gammaknife surgery has led to this minimally invasive procedure being performed on an outpatient basis
HCE EXCHANGE MAGAZINE Real Issues : Real Solutions
75
20 | Larkin Community Hospital
“We want to train the next generation of physicians” INDUSTRY PARTNERS Laminates & Things www.laminatesandthings.com
of Medicare patients are readmitted to the hospi-
Furthermore, the HRSA grant will create curricu-
behavioral sciences for underserved students, their
tal within 30 days nationally with rates in Florida
lum and clinical training in medically underserved
siblings, and their families, as well as additional
averaging 23 percent. The program hopes to reduce
communities, which include rural and urban areas
educational opportunities for the residents.
that number through these discharge planning
where physicians and medical services are scarce.
and education strategies. Initial data indicates that
with the patient experiencing minimal hospital time
The funds will also be used to develop training
Focus on the future
these efforts have led Larkin Community Hospital
in other areas such as all-hazards preparedness,
With its emphasis on innovation, education, and
to an initial reduction of readmission rates by 10 to
genomics, and medical informatics. One of the
community partnerships, Larkin Community Hos-
20 percent.
grant’s goals is to encourage more primary-care
pital is well-positioned to benefit from the changes
residents to become practicing physicians in these
expected in the healthcare arena.
and extremely fast recovery time. These services
Focus on education
will further augment existing programs in arthritis
Another focus of the facility has been its commit-
and pain management as well as newly developed
ment to post-graduate medical education. Larkin
Focus on partnerships
cancer center.
has implemented a graduate medical education
Another strength of the facility is the strong rela-
laborative and mutually beneficial partnerships that
As part of its focus on innovation, Larkin has
underserved areas.
Larkin’s leadership team has focused on embracing and adapting to this change by maximizing opportunities to engage with other partners in col-
program in partnership with NOVA South Eastern
tionships it shares with its community partners,
improve quality and patient care throughout
also embraced many of the initiatives set forth
University (NSU) and developed residency programs
which include three Federally Qualified Health
its community.
under the three-part aim directives championed
in family medicine, psychiatry, podiatry, internal
Centers (FQHC) and a network of community clinics
by the Center for Medicare and Medicaid Services
medicine, and neuromusculoskeletal medicine.
that offer comprehensive primary and specialty
(CMS). Under the “triple-aim” approach, improving
Additionally, residency programs in dermatol-
the U.S. healthcare system requires the simultane-
ogy and palliative care have recently been granted
hospital residents rotate through its sites to aug-
ous pursuit of three aims--improving the experi-
approval while several other programs are in
ment the medical care provided at the clinics, while
ence of care, improving the health of populations,
various stages of the approval. Through this rapid
the hospital has a more extensive network to pro-
and reducing per-capita costs of healthcare.
expansion of its graduate programs, Larkin expects
vide care and support to its patient base and
to become a statutory teaching institution within the
the community.
One of the first triple aim-related initiatives completed by Larkin was the full implementation
next couple of years.
of electronic medical records. Larkin was also an early volunteer for the Joint Commission’s Project
“We want to train the next generation of physicians” Sosa-Guerrero said.
RED (re-engineered discharge), a pilot project to
The Department of Health and Human Services
care. The FQHC benefit greatly from having the
The three FQHCs in the hospital network-Helen B. Bentley Health Center, Borinquen Medical Centers of Miami Dade, and Miami Beach Community Health Center--have expressed great satisfac-
improve discharge procedures and reduce re-
recently awarded a Health Resources and Services
tion with the support they are receiving from the
admission rates. This collaborative allowed the
Administration (HRSA) grant to Larkin Community
program as they are able to offer their patients
hospital to experiment with various approaches in
Hospital and NSU’s medical school. This five-year
access to specialist and other hospital-based pro-
order to find effective ways to bring about change in
federal grant will help educate medical residents to
grams and services.
the hospital rate of readmission.
provide expert care for patients living in rural and
As results formed and processes were rede-
by Patricia Chaney
Larkin is also establishing Wellness Centers
underserved communities. The HRSA grant will be
in partnership with the Miami Dade County School
signed, follow-up nursing and resident visits were
used to develop training programs for NSU’s Col-
System, the Children’s Trust, and the University of
implemented, as well as strong case-management
lege of Osteopathic Medicine’s affiliated medical-
Miami School of Medicine. These centers will pro-
coordination of aftercare services. About 20 percent
residency program at Larkin Community Hospital.
vide comprehensive services in family medicine and
HCE EXCHANGE MAGAZINE Real Issues : Real Solutions
77
21 | Lakeland HealthCare:
Lakeland HealthCare Like other organizations, Lakeland HealthCare, located in St. Joseph, Mich., is striving to stay abreast of healthcare’s rapid changes and impending reforms. “We provide excellent clinical care,” Sandy Sosa-Guerrero, CEO, said. “Our patients come here because we are able to provide comprehensive care with an emphasis on coordination of care throughout the continuum of care. We value working with our physicians and community partners to ensure that patients receive evidence-based recommended care in a safe and comfortable environment.”
INDUSTRY PARTNERS
Norma Tirado, Vice President, Human Resources and Health Information Technology
West Michigan Office Interiors (616) 396-7303 www.wmoi.com
Serving a community while successfully implementing EHR
thus putting us ahead of phase-one standards for
Tirado wants all of this new technology to be fully
technology support this methodology and create the
meaningful use.”
embraced by the system and its associates. Edu-
workflow improvements our associates have identi-
Nestled along the shores of Lake Michigan and
Furthermore, Lakeland HealthCare is facilitating Epic
cating the Lakeland community on the advanced
fied and requested.”
only a 90-minute drive from Chicago, Ill., Lakeland
implementation for non-employed physician practices
resources it has at its fingertips is a vital part of the
HealthCare includes four hospitals, an outpatient-
that have medical-staff privileges. Tirado said this
quest for innovative care.
surgery center, rehabilitation centers, long-term
is because Lakeland believes that patients are best
care residencies, hospice, home-care services, and
served if healthcare professionals in the area are all
future, they’re going to have to be able to success-
that the major way to prepare is by continuing to
physician practices.
using one EHR system. Lakeland is also working with
fully merge people and technology,” she said. “They
improve upon care delivery since future reimburse-
the health information exchange at Michigan Health
need to be able to help people understand how to
ments will come largely from positive outcomes.
employer. Nearly 4,000 associates provide clinical
Connect to integrate its EHR with those physician of-
use the technology in a way that delivers the best
Accompanying this preparation is an increased focus
and support services at locations throughout south-
fices and facilities that may not have Epic.
care for the patient and how to make technology
on core quality measures and patient satisfaction.
The health system is the community’s largest
Beyond simply implementing EHR, though, Tirado
west Michigan. Lakeland’s medical staff consists of
“For organizations to be successful in the
their friend – to embrace it and maximize it. Orga-
Preparing for healthcare reform With healthcare reform on the horizon, Tirado feels
In addition, Lakeland is investigating the benefits
almost 450 physicians and other allied-health pro-
said that Lakeland is taking the process one step
nizations spend a lot of money in technology, and
of becoming an accountable-care organization
viders, a quarter of whom are Lakeland-employed.
farther.
oftentimes, people don’t use all of the capabilities
(ACO). The system is also working to be more diver-
that the technology has.”
sified in its offerings. In the last year, Lakeland has
“We’re making sure that we’re building not just
A large part of Tirado’s responsibilities are centered on implementing technology and an EHR
what we need, but we’re changing workflows and
system that will improve upon Lakeland’s delivery
procedures to ensure that we can achieve meaningful
of patient care.
use,” she said.
Since choosing Epic Systems as its software
Caring for patients and associates Tirado said that Lakeland is also working with Dr.
formally integrated with a community hospital 16 miles northeast of St. Joseph. Currently, Tirado said, they are having conversations with a hospice-care provider about integrating into the Lakeland system.
vendor, a team of more than 70 Lakeland associ-
Inspiring innovation
ates have been working exclusively on the EHR
When Lakeland started its EHR project, Tirado said
Healthcare in Challenging Times, on developing a
like navigating in uncharted waters,” she said, “and
rollout for both their ambulatory and hospital
they built an innovation center that would give their
system that will provide patients with more precise
nobody is really sure what it is going to look like in
services. On Oct. 4, after more than a year of de-
implementation team an environment in which cre-
and efficient methods of receiving care. Key to this
the end.”
signing, building, testing, and training, 24 Lakeland
ativity would be fostered.
program is the involvement of care providers.
“Our goal is to inspire people to deliver the best
HealthCare affiliate physician practices went live
John Kenagy, author of Designed to Adapt: Leading
“We want our providers to look closely at what
“Preparing for healthcare reform right now is
“One thing is for certain,” Tirado added, “Lakeland intends to stay ahead of the game, and to do
care and to do it through creating an emotional con-
they’re doing and say, ‘Am I doing it in a safe way?
that, we will ensure we are providing the best care
nection between what we’re trying to accomplish and
Am I doing it in an efficient way? What do I need to
and using technology in a way that ensures our
tices to go live first,” Tirado said. “The goal for the
the work that each person is doing,” she said. “So
do to make this workflow better for the patient?’”
patients will get the best outcomes.”
overall system is to be at a HIMSS (Healthcare
now they’re thinking about more than how to get the
Tirado said. “We are working towards giving our
Information and Management Systems Society)
system up and running; they’re thinking about how it
patients exactly what they need, when they need
level six by the time Lakeland’s hospitals go live,
will affect the patient.”
it, consequently lowering costs. Our advances in
with Epic. “The plan was always for the Lakeland prac-
by Pete Fernbaugh
HCE EXCHANGE MAGAZINE Real Issues : Real Solutions
79
22 | Norwalk Community Health Center
Norwalk Community Health Center In just 12 short years of being opened as a federally qualified community health center, Norwalk Community Health Center has seen huge changes in quality, service, and facility size. The center opened in 1999 in a 10,000-square-foot building in Norwalk, Conn. Today, the center is located in a 24,500-square-foot, state-of-the-art facility that serves 11,000 residents and provides more than 42,000 medical office visits every year. The center offers services in three major departments--adult medicine, obstetrics and gynecology, and pediatrics. Norwalk also has a social-service department and an eligibility department, which helps people who are eligible for insurance obtain insurance. The facility also provides free transportation to qualified patients. With the recent move into a large facility, Norwalk has hired additional medical staff as well as a new chief medical officer, director of operations, and an EMR manager to oversee implementation efforts of the GE Centricity electronic medical records system.
Putting patients first Dr. David Savarese, Norwalk’s Medical Director,
Commitment to quality and meaningful use
said with the growth and expansion, a major effort
Today, quality, efficiency, and electronic medical
has been underway at the facility to improve patient
records tend to go hand-in-hand. Norwalk imple-
satisfaction through better customer-services
mented Centricity in the pediatrics department
skills. Having spent 20 years in community health,
in 2009, then moved to adult medicine in April
Savarese brought his knowledge to the staff, adding
2010 and to OB/GYN in October 2010. The center
training for all staff in customer service.
is steadily looking at ways to use the system’s
“I couldn’t imagine a better place to work than Norwalk,” he said. “Every person here is gifted at
features to improve quality and efficiency and is on track to achieve meaningful use. Norwalk has implemented the labs, orders,
interacting with the public, they are always smiling, always professional and enthusiastic about doing
and referrals modules offered by the EMR and
the best job they can do.”
coordinates closely with the Information Technol-
However, this staff has developed from the
ogy Department of Norwalk Hospital to improve
intense focus placed on customer service. Savarese
the flow of data from the hospital to the individual
said he couldn’t say the same about the atmo-
patient records at the center. Savarese said quality is one of the top priorities
sphere when he first joined Norwalk, but the staff that wasn’t on board with the changes found other
of the center, looking at improving scores on clini-
opportunities and new hires were chosen for their
cal measures and improving the number of patients
alignment with Norwalk’s key values.
who receive preventive-health measures such as
In addition to staff interaction, Savarese also
annual screenings. The EMR has been an excellent
made improvements to scheduling, decreasing wait
tool for monitoring these quality measures, and
times, and increasing efficiency and patient flow
the center is looking toward further increasing its
throughout the office, which also contributed to
capability in reporting on quality measures.
patient satisfaction. Patients are more often scheduled with their regular doctor and not the covering physician.
particularly for community health centers as more people receive Medicaid or Medicare. “We are the primary people that serve the Medicaid population,” he said. “We expect that demand to increase and are ensuring that we have the capability to deliver those services.” Despite tremendous growth in its short history, Norwalk is looking for even more expansion in the future. Norwalk has applied to become a certified Patient-Centered Medical Home (PCMH), which is a national initiative. A Patient-Centered Medical Home provides coordinated primary care for adults and children in a manner that treats patients and their families as partners along with their physician in making healthcare decisions. Norwalk is also seeking certification to provide behavioral health services. Through these improvements, Norwalk is committed to providing the best care possible to its patients. “We want to make it such that everyone would want to have us as their healthcare provider,” Savarese said. by Patricia Chaney
Continuing growth into the future Savarese expects that over the coming years, the demand for healthcare services will increase,
HCE EXCHANGE MAGAZINE Real Issues : Real Solutions
81
23 | West Gables Rehabilitation Hospital hospital’s promotion may help build a solid reputation, but it also increases the need for clear, correct education. West Gables features two distinct entities between its rehabilitation hospital and its skilled nursing facility. The rehabilitation hospital is part of Select Medical and occupies the first and second floors of the facility. West Gables Health Care Center, the skilled nursing facility, is on the third and fourth floors of the building and is owned by Preferred Care Partners Management Group.
Upgrading for the future West Gables is CARF accredited for inpatient acute
West Gables Rehabilitation Hospital is seeing results.
rehabilitation and stroke specialty programs, and the hospital has received the Joint Commission’s Gold Seal of Approval. “By having rehabilitation and skilled nursing in
West Gables Rehabilitation Hospital
one building for the past 10 years, we have been a one-stop shop for patients,” Concepcion said. “With
So can you. Join the largest connected network in the nation—and in your community. Partner with Allscripts today.
new Medicare regulations, we believe this could be
Walter L. Concepcion, CEO
Located in Miami-Dade County, West Gables Rehabilitation Hospital is quickly pursuing its place in a highly competitive market. The 180bed hospital includes a 60-bed inpatient acute rehabilitation hospital on its first and second floors and a skilled nursing facility on its third and fourth floors.
the future of most facilities.”
Located in a district with dozens of skilled nursing facilities and seven rehabilitation hospitals, West Gables faces stiff competition. CEO Walter Concepcion said the hospital consistently works to provide the highest level of care along with education for patients and local physicians.
pated outcome--West Gables is now the top food
West Gables continues to work on becoming one entity. Recently, the rehabilitation hospital was renovated with new flooring, a new roof, low-main-
www.allscripts.com
tenance lighting, and 40 new parking spaces. A new cafeteria was also built, resulting in an unanticidestination, even among staff and patients from surrounding hospitals. And, in an important upgrade for any facility so close to the Tropics, by the first quarter of 2012, the entire hospital will have new hurricane-resistant windows. A major area of capital spending over the past
half are seen on a two-to-one basis. Concepcion expects to raise the percentage of one-on-one care in the coming years.
The next 22 years Concepcion said the hospital is committed to provid-
Community education
nursing facilities in South Florida changing their
two years has been rebuilding the inpatient and
ing quality, culturally sensitive care. With a 22-year
“Whether we teach patients of the extra steps taken
names to rehabilitation facilities, the challenge has
outpatient therapy gyms. These gyms feature state-
track record, the hospital’s physical therapy staff is
to provide good care or we teach physicians about
only increased.
of-art equipment for physical and occupational
among the best in the area, according to the CEO.
therapy. In addition, the skilled nursing facility
“For patients, we are home away from home,”
“Skilled nursing facilities do not provide the
our services, we must always be in education mode, deep within the community,” Concepcion said. “It is
same services as a rehabilitation hospital, nor do
includes a 900 square-foot gym to provide a similar
he said. “After a time, we also become like family
doubly important because with so many changes in
they conform to the same Medicare standards,”
level of physical therapy care that a patient would
to our patients, except we are highly trained. The
medical rulings, it is harder to get patients into the
Concepcion said. “As just one example, to be
receive in the rehabilitation hospital. This is a major
culture of teamwork here is strong. And because we
hospital.”
compliant with Medicare, we must do a minimum
benefit to patients.
have been helping people with their rehab for more
Because of changes in Medicare, a patient who
of three hours of rehabilitation each and every day.
“Even though we have all of this equipment to
had a knee replacement a year ago and now wants
We have to educate doctors and patients on how we
work with the patient, the best way to help our pa-
to have the second knee worked on may not be ad-
are different.”
tients is to use it while they are in therapy,” Concep-
Hospital admissions primarily come from phy-
mitted today. Providing updated information about these changes to physicians and patients is a major
sicians and patients with friends or family mem-
challenge for the hospital. And with some skilled
bers as patients. The word-of-mouth nature of the
cion said. “We encourage them, and we set goals.”
than two decades, we can honestly say we have what it takes to provide the very best service.” by Patricia Chaney
At present, half of the 100 patients typically at West Gables receive one-on-one care. The other HCE EXCHANGE MAGAZINE
Real Issues : Real Solutions
83
24 | Health Inventures
Health Inventures Coordinated care and physician employment are trends across all healthcare organizations. With the future of healthcare reform uncertain, hospitals, physician practices, and other healthcare entities are looking for ways to remain profitable and efficient no matter what comes their way. Health Inventures is positioned to help organizations adapt to changes, particularly through managing physician relationships, productivity, and human-resource issues.
Dr. Chuck Peck, CEO
Currently, Health Inventures is primarily involved in ambulatory surgery centers, serving as consultants to 30 centers, but the group also has two surgical subspecialty hospitals and provides service in physician practice management and inpatient perioperative management. The company’s primary goal is to help manage physician relationships, but it also helps organizations with supply-chain management, productivity, and employee management solutions.
Why wait 90 days to get paid?
touches the patient. Health Inventures is positioned to help hospitals manage relationships with physicians in acquisitions or other arrangements.”
A shift to outpatient surgery Another shift in the healthcare business that Peck sees is more emphasis on outpatient surgery. Surgery provides the highest revenue for hospitals, but many procedures that can safely be done in an ambulatory surgery center are still done on a costlier inpatient basis. Once reimbursements decrease or
“We have a physician-hospital joint-venture model,
surgery centers that are cash-strapped and looking
payment becomes based on performance, hospitals
which is different than the traditional equity-based
for someone who can bring cash to the table.
are more likely to provide those services in a less
model,” said Dr. Chuck Peck, chief executive of-
Health Inventures has a small equity stake in
expensive outpatient setting.
about 20 percent of the ambulatory surgery centers
we put hospitals and physicians together in joint
it works with, but the company does not follow the
by money, and I think we will see a shift toward out-
equity model, which provides a short-term solution.
patient care more than we’ve seen recently,” Peck
Peck said he is more interested in helping organi-
said. “How people are reimbursed is what will really
lationships with employed physicians and between
zations develop a culture of partnerships, where
drive people to examine safety and quality data for
employed and private physicians. Health Inventures
the primary stakeholders are hospital personnel
providing surgical services in an outpatient setting.”
works with hospitals or other organizations to
and physicians, to provide a long-term solution.
Overall, the future of healthcare will require
Many hospitals struggle with how to manage re-
manage those relationships and ensure that both
Peck said that about 15 percent of the ambula-
clinical integration between hospitals and physi-
parties remain successful and have a long-term
tory surgery centers are managed by professional
cians, which Health Inventures is well-positioned to
relationship.
organizations. Most are owned by physicians,
continue providing.
“No matter what reform ends up bringing,
and many are looking at how they will continue to
“Care coordination among all parties is critical
the only way our current system will improve is
provide service in the future. The ability to dem-
if we are going to reduce readmissions and improve
if all people providing care -- physicians, nurses,
onstrate quality data is a growing demand across
safety,” Peck said.
patients, administrators -- are all in this together,”
all of healthcare, and ambulatory surgery centers
Peck said. “The fragmentation of business in this
are beginning to track more, but data is still a little
industry is probably one of the main reasons it’s in
behind that of most hospitals. With increasing care
patient informed.
the shape it’s in. The culture of medicine is chang-
coordination and demands to do more with less,
ing, and providers are thinking about relationships
hospitals may own or partner with these centers.
A new way of doing business
“In the future, I don’t think hospitals are going
and hospitals meet the new demands and adapt
uct line, including what happens to patients when
their cultures to the future of healthcare delivery.
require hospitals to be connected to everyone who
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INDUSTRY PARTNERS Medical Web Technologies Technology for Better Patient Care (TM) www.mwtcorp.com
vice-line arena. He anticipates the company growing
as separate service lines, but at the whole prodthey are out of the hospital,” Peck said. “That will
Q Reduce Accounts Receivable and collection costs
ventures as being a major player in the surgical serand expanding resources to help surgery centers
is when talking to many hospitals or ambulatory
Q Offer patients convenient, monthly payment plans
With all of these changes, Peck sees Health In-
to look at inpatient surgery and outpatient surgery
“Peck said one challenge Health Inventures faces
®
Integrated electronic medical records are also critical to keeping all parties involved in caring for a
and who their partners should be.”
with CareCredit Patient Payment Plans
“The shift in how care is provided will be driven
ficer. “We provide a longer-term partnership where ventures that are mutually beneficial.”
Receive your facility fee now
by Patricia Chaney
HCE EXCHANGE MAGAZINE Real Issues : Real Solutions
85
25 | Rockingham Memorial Hospital
Rockingham Memorial Hospital Incorporating flexibility and sustainability
Dennis Coffman, Director of Facility Planning & Development
Until June 22, 2010, Rockingham Memorial Hospital, located in Harrisonburg, Va., had been situated on a small 18-acre campus within the city limits since its founding in 1912. With James Madison University on one side and “Old Town” Harrisonburg on the other side, the hospital was a local fixture, even if it was limited in its ability to expand.
Coffman and his steering team, Destination Health,
In 2001, the hospital began to explore the possibility of a rotating construction schedule as they sought to regenerate their facilities. According to the plan, each facility would be upgraded over the course of 15 years. Unfortunately, by that point, the buildings that had been originally remodeled would be ready for another round of construction.
were located on the outside areas of a department
When faced with this reality, not to mention the high cost of the situation, RMH officials arrived at one conclusion.
cating an office or service next to a department that
worked intensely on planning and pre-construction to ensure that the new design would be as efficient as possible. This included making sure that procedure rooms were flexible enough to accom-
Inspired healthcare Inspired design
modate future technology and that these rooms so changes wouldn’t be disruptive. They also planned for three years of growth in the new facility, making it vital to avoid permanently lo-
Celebrating 25 years of partnership with RMH www.ksainteriors.com
was rapidly growing and expanding. For example, they built unoccupied infrastructure space that will enable the hospital to add two more patient floors and another 144 beds in the near future. “We knew that we were occupying in June of 2010, but we did our growth projections based upon 2013,” Coffman said. “So as we built the building,
It was time to move. And this time, the campus would need to have leg room. “We wanted to make sure that what we got was a campus that was big enough to support any of the directions that we think our community would need for us to go in,” said Dennis Coffman, director of facility planning and development and project manager for the new hospital. After various meetings and consultations, Coffman and senior hospital officials decided to build the new RMH campus on a greenfield site. Several months of in-depth research into various locations followed, as well as examining with county officials the logistics of how this new hospital would fit into the Harrisonburg community. In August 2006, RMH broke ground on the selected site, a 254-acre piece of land that now houses their full-service, 620,000-sq.-ft., 238-bed hospital and is located just two tenths of a mile outside of the city limits and about two miles from the original site.
we had a plan for what each one of those department-growth strategies would be for each of those three additional years.” Then, there was LEED certification. Coffman said he started out hoping for LEED silver, was willing to settle for mere certification, but dreamed of LEED gold. His dream would be hard to achieve, however, especially when the board mandated that LEED points could not result in increased building costs. In its pursuit of LEED, the hospital first examined the wetlands on which the building would be erected. Because the site was formerly a working farm, RMH opted to partner with JMU on returning the acreage to its natural state. RMH also worked with an Eagle Scout, allowing him to build nesting boxes and observation boxes as part of his community project. “Now, we’re encouraging people to observe the wildlife of the wetlands, enjoy the natural setting, and make this area something that we’re proud to
HCE EXCHANGE MAGAZINE Real Issues : Real Solutions
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have on our campus rather than something that we wish would go away and that we could build on top of,” Coffman said. Coffman also found that installing a white roof on the building cost less than a conventional roof because of the material used. Elsewhere, the hospital worked up a contract with Rockingham County to use methane gas produced by a local landfill
R.C. Smith is proud to be the casework supplier of the new state-of-the-art pharmacy at Rockingham Memorial Hospital.
as a fuel source for their boilers, thus enabling the county to generate revenue from a previously untapped source.
Prepared for an emergency
“I need to make sure that we have the right other people at the table who are champions and passionate about their individual pieces, and we all work together, and we all respect where each person’s coming from, so it blends together.”
Also within the new building, Coffman said they MODULAR CASEWORK FOR PHARMACY, LABORATORY AND CLINICAL AREAS
prepared RMH for any future disasters or emergencies that may take place. The boilers, heating, and cooling systems can all operate on diesel fuel, natural gas, and methane gas. If one market plays out at a given time, then RMH can fall back on two
Call Toll-Free at 1(800)747-7648 or visit www.rcsmith.com.
others. Thanks to a deal worked out with the local electric company, the hospital is 100-percent backed
AD SIZE: Quarter Page (3.38” X 4.63”) CLIENT: R.C. Smith Company IN-FOCUS ARTICLE: Rockingham Memorial Hospital CONTACT: Peter Smith, 952.259.1001
up by generators and can go off the grid at peak load times to get a better electrical rate. If there’s an ice storm or some other weather condition that will disrupt electricity, RMH can disconnect with the utility and continue operating without concern for what happens to the local grid system. Future plans include working with the county to construct a one million-gallon water tank on an unused section of the campus, which will allow the county to stabilize water pressure in the area. If there was ever a water emergency, the county would shut off the valves on the water tank so it would feed only the hospital. One million gallons could last approximately two weeks. “If there was ever a disaster in our area, the hospital would be a good haven for the local com-
state of Virginia to do so and one of only seven hospitals in the country that are over 100,000 sq. ft. “You always hear that trying to be a sustainable facility costs more money, and I would say that that’s not necessarily the case,” Coffman said. “If you do good planning upfront and you make the right decisions, either because it’s what you would do for your customers or you would do because there’s a good return on investment, then you can build a sustainable building and really not cost you any more money.” But most important for a successful project, Coffman said you need to have a good team that rallies together. “I don’t know that much about clinical,” he said. “I don’t need to know everything about clinical. I need to make sure that we have the right other people at the table who are champions and passionate about their individual pieces, and we all work together, and we all respect where each person’s coming from, so it blends together.” by Pete Fernbaugh
munity to depend on,” Coffman said. Thanks to all of these common-sense measures Coffman and his team took, he achieved his dream of LEED gold certification, the first hospital in the
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OCT/NOV
2011
Real Issues : Real Solutions
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