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Real Issues : Real Solutions

Children’s Hospital Boston Balancing science and care

MAR/APR 2011

HEALTHCARE EXECUTIVE EXCHANGE MAGAZINE | www.hcemag.com

Real Issues : Real Solutions

CONTENTS

06 Children’s Hospital Boston

IN-FOCUS STORIES 10

Christian Homes, Inc.

Children’s Medical Center

NextCare Urgent Care

21 Antelope Valley Healthcare District

Sandra Fenwick

Deaconess Health System

Delphi Healthcare Partners

Gwinnett Medical Center

Huelat Parimucha, Ltd

Jefferson County Health Center

National Naval Medical Center

Silver Hill Hospital

The Hamister Group

Winchester Gardens

NHS Human Services

Coulee Medical Center

52 Tampa General Hospital

President, Children’s Hospital Boston

Wyoming Medical Center

The University of Kansas Medical Center

60 Avera McKennan Laboratory 63

Catholic Medical Partners

66 Brighton Hospital

HCE EXCHANGE

MAR/APR

2011

Delta Regional Medical Center

DuPage Medical Group

Gilbert Hospital

Providence Health and Services

Schneider Regional Medical Center

St. Joseph’s Health System

UMass Memorial Medical Center

Quality and Safety Programs for Unsurpassed Care On the clinical side, everything contributes to unsur-

are hiring people who are not just clinical experts or research experts, but quality experts. That’s part of their institutional and professional role.”

passed care. “Over the last five years, we have put an enormous emphasis on our quality and safety programs,” Fenwick said. “We are making some incredible headway. We have a five-part strategic plan for quality

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and safety, and it has taken hold and been embraced

Owens & Minor, the industry leader for

across the entire institution.”

medical and surgical supply distribution, is

An emphasis on quality has been added to every component of Children’s services. “How do we look at governance and accountabili-

proud to be the primary supplier for Children’s Hospital Boston. For more than 125 years, we have been providing best-in-class

ty? How are we going to increasingly do more evi-

distribution services across the country and

dence-based review of care?” Fenwick said. “We are

have expanded our capabilities to include a

looking at outcomes, not just process measures. We

diverse mix of supply chain solutions, innova-

are benchmarking ourselves against ourselves, and

tive technology, inventory management, and

then benchmarking our care outside the institution,

consulting services.

particularly against other peer pediatric providers. “It’s a very comprehensive look, and we’re excited

With this broad portfolio of programs and ser-

because we are rigorously tracking this and we’re

vices for the healthcare supply chain, we’re

holding people accountable. But the most exciting

dramatically reducing costs for healthcare

part is the cultural change we have experienced. We

systems of all sizes – and we look forward to having the same impact for Children’s Hospital Boston.

Children’s Hospital Boston “Children’s Hospital Boston is not only a large and very important contributor to the best pediatric care at the local, regional, national and international level, but we also blend scientific discovery with the most advanced pediatric clinical care. Our sweet spot is that translation - the interface between science and care,” said Sandra Fenwick, President and COO of Children’s Hospital Boston, one of the largest pediatric medical centers in the United States. The 396-bed pediatric hospital is staffed by 1,077 physicians and dentists, and 181 other physicians hold courtesy or consulting status. The professional staff of more than 3,000 includes almost 1,000 residents, interns and fellows. It is the primary teaching hospital in pediatrics at Harvard Medical School.

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Sodexo Health Care Sodexo Health Care is a strategic partner to hundreds of leading health care facilities and institutions in North America, including the renowned Children’s of Boston, providing on-site services and innovative solutions that improve the patient experience and outcomes in hospitals and other health care settings by making Patients the Heart of Everything We Dosm. Through the team spirit, service spirit, passion and expertise of our employees, we help make every day a better day and enhance the patient experience for millions of hospital patients, their loved ones and friends, plus medical and other hospital staff.

Translating Research to the Bedside

support them with seed grants, resources, and other

On the research side, they are working hard to remove

they can both look for funding and communicate with

barriers and to support the translation of basic sci-

other innovators.

ence and research to the bedside. the care and the care re-informs the science?” Fen-

Excellent, Affordable Patient Care

wick said. “Increasingly, you realize there are so many

As at every hospital, cost of services is a concern

elements to supporting that.”

at Children’s.

“How do we close the loop so the science informs

Information Technology, using Cerner as their

Exceptional experiences. Exceptional outcom mes. Our unique e culture is designed to raise your patients’ spirits—and your satisfaction scores. With O.J. Hoffmann, he showed our innovative Skylight system to a you ung patient—then treated the e boy to three days of games and movies. To learn how we can help you enhance the patientt experience, along with your HCAHPS scores, nursing satisfaction, employee engagement and other important metrics, visit sodexoUSA.com 800.4 432.6663

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measures such as scientific forums or websites where

“In the last three years we have gone across the

primary IT system, is one way the organization is as-

organization and actually identified a hundred million

suring this goal.

dollars of savings,” Fenwick said. “We have taken that

“We have spent a fair amount on new technology,”

out of our budgets in fiscal years 2010 and 2011. We

Fenwick said. “We are also building a small new clini-

went back to the payers and said, ‘We will return the

cal building, and part of that new building will help us

majority of these savings to you. We actually cut our

advance technology at the bedside.”

prices in some of the services that even patients pay a

As well, Children’s hired their first Chief Innovation Officer whose role is to go throughout the organization and identify innovators, as well as to help

portion of through their co-insurance.” The hospital went back to its three major payers, which make up over 60 percent of their business, and

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â&#x20AC;&#x153;We also asked them to set aside with us $10 million of these savings in each of the next two years,â&#x20AC;? Fenwick said. â&#x20AC;&#x153;We collectively took that out of the patient care revenues and put it into a fund at the hospital and then asked them to join us in an advisory board where we would work on a series of initiatives at the hospital to reduce cost, improve health-related outcomes and transform current practice. We will continue to gener-

â&#x20AC;&#x153;They have the opportunity to transform both pediatric and adult care elsewhere.â&#x20AC;?

ate savings through reduced utilization and by how care is actually delivered.â&#x20AC;? They have funded six projects in the first year of this initiative and are in the process of monitoring those projects. â&#x20AC;&#x153;The exciting part is that not only will they transform the delivery of pediatric care at Childrenâ&#x20AC;&#x2122;s, they have the opportunity to transform both pediatric and adult care elsewhere,â&#x20AC;? she said.

â&#x20AC;&#x153;The only way we can continue to do that is if we all figure out how to deliver real valueâ&#x20AC;&#x201D;care that is effective, efficacious and cost-efficient.â&#x20AC;?

Increasing Effectiveness for the Future â&#x20AC;&#x153;I think that all of us as leaders in healthcare have to take responsibility and ownership to both reduce the cost of our services while concurrently increasing the effectiveness and the efficiency of what we provide,â&#x20AC;? Fenwick said. â&#x20AC;&#x153;That is our responsibility. Obviously, if we donâ&#x20AC;&#x2122;t do that, all the work we do to innovate, both the delivery system and the actual care itself, is at risk. I think thatâ&#x20AC;&#x2122;s the message weâ&#x20AC;&#x2122;re trying to give internally. We own a part of this. We are employers ourselves, and we have a mission to continue to train the next generation, further the science and innovation and to give back to our communities. The only way we can continue to do that is if we all figure out how to deliver real valueâ&#x20AC;&#x201D;care that is effective, efficacious and cost-efficient.â&#x20AC;? By T.M. Simmons

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

02 | Christian Homes, Inc.

Christian Homes, Inc.

The second largest not-for-profit senior healthcare center in the U.S. began as a 48-bed nursing home in 1962 in Lincoln, Illinois. Christian Homes now operates 16 campuses in five states, including Ohio, Indiana, Missouri, Iowa and Illinois. They serve approximately 3,000 residents. Approximately half of those residents require skilled nursing care. Christian Homes has more than 300 supporting churches and thousands of volunteers each year coming from those churches to serve in the organization.

Tim Phillippe, CEO

“We are working diligently to stay up to date and to meet the changing needs of the seniors of the future,” Tim Phillippe, CEO of Christian Homes since 2001, said. “Our campus environment looks more social in model. We provide healthcare in places that look more like housing, apartment living or studios. We also provide more independence, freedom and choice for the residents.”

Resident-Driven Programming “We probably face the same issues as most people in our field right now,” Phillippe said. “The needs and expectations of the elderly are changing rapidly. They are growing in number and have more chronic health issues than they have had in the past. The people we serve come to campus with more acute health issues and more chronic types of conditions. Adapting our program for clinical excellence is important.” The previous generation of seniors was known as the Silent Generation. “Those were people who were more easily satisfied, less demanding, more loyal and trusting,” Phillippe said. This up-and-coming population of seniors, the Baby Boomers, however, have higher expectations and expect a strong role in controlling their own lifestyle through their senior years. Christian Homes has been working to meet this demand by creating more programs with strong resident councils. As much as is possible, the residents are in charge of determining the lifestyle, the activities and the programs offered on campus. Real Issues : Real Solutions

03 | Children’s Medical Center

“We need to have more program flexibility because

They also provide a lot more flexibility and choice.

choice is very important,” Phillippe said.

We can be flexible and do what the residents want to do. We can schedule activities that the residents

Changing the Look of the Hospital Environment

themselves chose to have. “We strive for compassionate, Christian care that

Typical long-term care in Midwest has looked much

aggressively meets the needs of our residents, for

like hospitals from the 1960s and 70s--two people to a

quality and for choice. Those are the two elements--

room evenly spaced on each side of a long corridor.

quality and choice in a Christian environment.”

Just like hospitals, senior living and senior care facilities have been remodeling, “even more rapidly to

By T.M. Simmons

try to look more like a home environment,” Phillippe said. “We have units with carpet and flat panel televisions. They look like studio apartments with a microwave, phone, separate dining areas and smaller wings in a home-like setting. Everything can be geared more to the individual, rather than the large group.” Private rooms are standard even in skilled nursing areas now. Assisted and independent living might be built as duplex garden homes where maintenance and landscaping are part of the package. As most seniors want more and bigger spaces than were once standard, two-bedroom apartments are now common for assisted living spaces, as well. But more important than space and aesthetics, the emphasis that permeates Christian Homes’ campuses is community. More than just building modern spaces for modern seniors, Phillippe said the goal is that people feel as if they are moving into a community, not just a room or an apartment. “We have a really strong Christian component

Children’s Medical Center

within our campuses,” he says. “Each of our campuses has a chaplain on staff and a full range of church-type activities, Bible studies and worship, along with pastoral care, which is so important for

One healthcare role that has evolved tremendously in recent decades is that of the information technologist or information systems manager. It’s no longer just about computers, but about networks of systems that carry patient data and connect sensitive medical instruments and testing devices to physicians even in hospitals where the tests themselves are not being taken.

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people who are sick.”

Seniors at Home “One of our residents said, ‘I don’t like it when people

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call this a facility. This is my home,’” Phillippe said. “People should feel that way. When you break the groups in skilled care into smaller communities, say a wing of 12 people, the staff working with them are dedicated to those residents. They get to know them.

Pamela Arora, Vice President and CIO

The IT component of Children’s Medical Center, with hospitals in Dallas and Plano, Texas, is an excellent example of that as the whole organization works to make life better for children with approximately 360,000 patient visits per year. The organization also has ambulatory and outpatient centers. It is the seventh largest pediatric hospital in the United States.

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

ent entities that are separate organizations, but are

our organization as a tool, it needs to be opened up to

joined in wanting to make care better for the commu-

patients and families,” says Arora.

nity,” says Arora. getting care at Parkland Hospital, one of Children’s

Keys to Successful Growth of Technology in Hospitals

community partners, but for that child to be getting

“I think one of the most critical aspects in our suc-

additional services, such as MRI scans, at Children’s.

cess with technology is getting engagement from the

The new EMR allows the information to easily flow

organization,” says Arora. “It’s not enough to put in

In recent years, Children’s has invested $65 million of

between hospitals. All of this results in safer care

the EMR, we need to have key physician and other

capital in information technology. They transitioned

because it is informed care. “If someone goes into the

clinical champions across the organization that are

from a Cerner EMR platform to an Epic platform. The

emergency department, you want to know about their

really promoting its utility and, when there are issues,

new medical record was employed across all ambula-

allergies and this might not be noted when they come

highlighting the direction that needs to be taken.”

tory and outpatient settings, as well as specialty care

in unconscious. You want caregivers to be aware.

and primary care facilities. “It is giving our organiza-

We’ve laid the groundwork by developing standards

ers—the chief nursing officer, head of surgery, vice

tion returns as far as efficiency,” says Arora. “Also, it

across our campus for health information sharing,”

president of quality, and chief medical officer, among

is allowing us to scale [our services] so that we can

says Arora.

others—who met weekly to discuss their technol-

It is not uncommon, for instance, for a child to be

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reach more children.”

“The role of technology is focused on making life better for children with tools that allow the organization

ogy needs and progress. “When you bring together a

more likely to follow the patient. Because the entire

Technology for the Patient as well as for the Patient’s Care

organization is linked, what happens at each location

Helping physicians to better serve patients is not the

the tough decisions need to be made. They’re going

is documented in a way that it is easily accessible the

limit of technology, however. In one application, the

back to the organization and helping us on communi-

next time that child enters the healthcare setting,

organization is focusing on the online experience of

cation needs and training. Ultimately, they are owning

even if they are there for a different purpose.

children and their families. “We have private, social

the electronic medical health record,” says Arora.

network solutions that provide a virtual support group

“One of the key aspects and critical success factors is

By adding the EMR to their ambulatory and specialty clinics, for instance, a medical record is

Technology as a Tool of Efficiency

Children’s began with appointed department lead-

The organization purposely selected the platform

group like that and you are working through the decisions the organization needs to make around standardization, you have the champions in the room when

to be more efficient and to deliver safer care,” says

being used by their partner hospitals in order to allow

for patients and families … We see that as helping

that everyone, the clinical as well as the billing folks

Pamela Arora, Vice President and Chief Information

for deeper sharing. “When a resident or a doctor is

serve, making lives better for children in this commu-

using the system, feel it is their system. It is not the

Officer. “When you also layer on our affiliation with UT

working in these multiple environments, they can

nity because it’s connecting parents with parents and

system [belonging to] the IT department.”

Southwestern as a teaching hospital, we’re raising the

deliver safer care because it’s a familiar platform to

other experts relative to the unique needs that their

knowledge level in the industry.”

them. We’re using like standards across three differ-

child has. Technology not only needs to be brought to

by T.M. Simmons

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

04 | NextCare Urgent Care

A New Dimension of Healthcare

The Technology Picture in Urgent Care

Studies suggest that anywhere from 20 to 40 percent

“We feel that we are the very leader in technology,”

of emergency room visits are not for emergency con-

says Julian. They have the capability to register

ditions. As a relatively new portion of the healthcare

patients online. A person can wait for a room to be

industry, urgent care has seen rather fragmented

available at their own home or office. Data for the

growth. “There are a lot of mom and pop physician of-

electronic medical record is captured in advance. “We

fices that have dabbled in urgent care,” says Julian. “I think we’ll see some consolidation over the next few years.” NextCare is always looking for expansion oppor-

“We feel that we are the very leader in technology.”

tunities and they are willing to partner with existing systems and hospitals. “We are certainly looking for a hospital system that understands the value of urgent care,” he says. “One that understands that if they want to have better relationships with the payers, they need

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more cost effective and convenient ways to deal with

small and large sign programs and can tailor a

healthcare needs.”

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NextCare Urgent Care Are you looking for signs or signage solutions?

Seventeen years in business have brought NextCare Urgent Care from a single facility opened in Arizona in 1993 to being one of the largest, privately held urgent care companies with sixty-two clinics operating in seven states; Arizona, Colorado, Texas, Georgia, Ohio, Virginia and North Carolina. NextCare clinics are generally located in retail settings and designed with a non-institutional look in mind. Wood flooring and soft colors fit the retail atmosphere. They are often located just outside of a shopping center or grocery store. The typical clinic has 4,000 square feet and 6-8 exam rooms. They are situated close to where people live and work.

John Julian, CEO

“We occupy the space in between the primary care physician and the emergency department, says John Julian, CEO. “As payers continue to find ways to have more cost effective care for their members, we have a unique opportunity to be in that mid-ground where folks don’t necessarily have an emergency condition and they could be served in an urgent care setting quickly, conveniently, cost effectively and urgently. I feel that this is truly going to be an excellent space to be in for the future.”

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Discover Why Over 60,000 Physician Offices and Urgent Care Centers Rely On Us For Supplies and More.

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05 | Antelope Valley Healthcare District have a completely paperless environment. Patients can come in and input their data either with one of our representatives or by themselves at a kiosk. That information is loaded into our electronic medical record that the physician utilizes to document everything involved with a patient.” Patients are generally sent home with a complete medical record. “We really want to make sure that not only is the patient care second to none, we want to make sure that the patient experience, when they come in the door to when they leave, is certainly much more convenient than going to an emergency room and waiting for hours on end.”

Keeping the Care Local Though they are a large company with clinics in several states, the emphasis for each clinic remains the 5-10 miles surrounding that clinic. “We’re very careful not to think that just by developing a national brand, and some partnerships on a national level, that it is going to drive into the little towns and cities across the country. It really has to be a local market focus where you have a good quality physician caring for those people and they rely on him or her and come back over and over again,” says Julian. People may try out urgent care for various reasons. Sometimes it’s simply because they have no

insurance and when push comes to shove, the urgent care clinic is an easy and affordable way to be seen for a condition that may have been put off due to lack of insurance. At the same time, urgent care clinics bring value to the delivery of healthcare in terms of the ability to save money. In spite of the economy, or perhaps because of it, urgent care business continues to grow. “The cost effectiveness of urgent care versus an emergency dept is indisputable,” says Julian. “Emergency departments have their place. If somebody is

Antelope Valley Healthcare District

having a cardiac event or some significant trauma, they need to go to the emergency room. But urgent care facilities can handle scrapes and sprains and

With increasing demands on hospitals to go paperless, the information systems departments are becoming integral to hospital operations. Antelope Valley Healthcare District, a 420-bed acute care hospital in Lancaster, California, has made drastic strides in the past few years to implement technology throughout the hospital.

light fractures and UTIs and strep and colds and flu; those things not requiring emergency care.”

McKesson Medical-Surgical At McKesson Medical-Surgical, our commitment

The Future of Urgent Care

to your practice goes far beyond supplies. Our

“Urgent care is a key piece in healthcare delivery in

knowledgeable representatives work with you to

this country. We’re not in competition with the primary

understand your needs and constantly seek new

care physicians; we’re here to support them. We’re

ways to help improve your practice. With a com-

not in competition with the emergency care depart-

prehensive line of quality products at competitive

ments; we’re here to support them. There’s a short-

prices, we make it simple to do business with a

age of primary care physicians in this country and, in

single supply partner – even providing reliable

general, ERs are expensive and crowded,” says Julian.

next-day delivery. And our innovative technologies

“Urgent care is only going to grow over the coming

and services make your job easier, enabling you

years, especially as we have more and more of an

to run your practice more efficiently. Simply put,

uninsured population out there. Those of us who are

we offer a higher level of commitment to you for a

in this space—NextCare included—are very excited to

higher level of performance at your practice.

grow and develop this industry and we view the future

New management played a part in making change, and incorporating information systems into planning and decision making has helped the hospital find success.

Edward Mirzabegian, CEO

During the past five years, the hospital has gone completely wireless, virtualized 190 servers, revamped its data center, and improved its infrastructure. “We are in the process of automating as much as we can,” Quintanar said. “Our goal is to go paperless, and we’re going to get there.”

as being very bright for us.” by T.M. Simmons

Humberto Quintanar, CIO Real Issues : Real Solutions

“When I started as CIO, the hospital was obsolete when it came to technology,” said Humberto Quintanar, chief information officer. “With the help of a new chief operating officer, we were able to do major upgrades to infrastructure and applications in the hospital.”

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ing the hospitalâ&#x20AC;&#x2122;s technology and brought Quintanar to the table during executive planning meetings. â&#x20AC;&#x153;My role has evolved from dealing with vendors ÂŠ 2011 NEC Corporation. All rights reserved.

ing an electronic medical record. Patient accounting and some nursing orders are already in place, and the hospital is in phase 2, which includes clinical documentation and electronic med administration; phase 3 includes CPOE. In conjunction with the medical

CEO,â&#x20AC;? said Quintanar. â&#x20AC;&#x153;Almost nothing happens in this

to implementing an EMR, revamping the PACS sys-

hospital where information systems is not involved. I

tem, and implementing many other systems, Quin-

am involved in everything that goes on from market-

tanar is evaluating mobile devices, carts, specialized

ing, to the copy center, to changes in the operating

arms in patient rooms with a computer screen and

or emergency rooms. We are trying to come up with

wireless keyboard, tablets, and even iPads.

system to revamp the distribution of drugs. Thatâ&#x20AC;&#x2122;s just the beginning of the hospitalâ&#x20AC;&#x2122;s plans for technology.

Antelope Valleyâ&#x20AC;&#x2122;s Chief Executive Officer Edward Mirzabegian began in this role in 2007, and served as COO for two years prior. He took an interest in improv-

systems,â&#x20AC;? Quintanar said. â&#x20AC;&#x153;We are having to balance security with the desire of physicians to have patient

see their needs, what instruments they are using, how

information on their mobile devices. Our biggest

helps healthcare providers transform clinical

they use the technology systems, what educational

strain right now is getting people to the point where

workflow through a suite of unified clinical collabo-

software they use or need, etc. He also is involved in

theyâ&#x20AC;&#x2122;re taking care of patients with something small in

ration solutions. NECâ&#x20AC;&#x2122;s healthcare solutions en-

creating processes that allow the hospital to track

their hand that they can use to chart, place orders or

able efficient clinical team collaboration, patient-

information reported to the Joint Commission.

dictate and move on.â&#x20AC;?

Information systems is an integral role in hospital

Quintanar said Mirzabegian is a high-energy CEO,

and codify essential â&#x20AC;&#x153;data bitesâ&#x20AC;? of information

operations, which has helped with the success of im-

who encourages the development of these technolo-

needed to address and organize the many unpre-

plementing various systems and initiatives. Quintanar

gies and to do it quickly. He said much of the hospital

dictable demands of delivering healthcare services.

is sensitive to the needs of the end users and works

is excited about the increased technology, particularly

An example of this is the wireless voice system

with them to provide technology in a way that benefits

with regard to the EMR implementation. Antelope

NEC developed for Antelope Valley Hospital that

their day to day work.

Valleyâ&#x20AC;&#x2122;s information systems department has a busy

allows staff and nurses to communicate no matter

Incorporating information systems in corporate planning

Quintanar spends time observing care providers to

â&#x20AC;&#x153;Currently, we have one of the most secure data

NEC, a global provider of IT solutions and services,

to-care team collaboration and the ability to access

record, the hospital has installed a new pharmacy

supportive of the desires of physicians and staff to have patient information at their fingertips. In addition

much better.â&#x20AC;? As with many hospitals, Antelope Valley is implement-

Quintanar and Antelope Valley are exceptionally

and managing contracts to sitting at the table with the

solutions that will make our patientsâ&#x20AC;&#x2122; experience NEC

information technology will be used in the facility.â&#x20AC;?

â&#x20AC;&#x153;As a CIO today, I have to speak many languages,

where they are at the facility. This has improved

from engineering to physicians to nursing to adminis-

patient care by being more accessible to other staff

trators,â&#x20AC;? he said. â&#x20AC;&#x153;I have many stakeholders, includ-

members and directly to the patient.

ing payers and private practice physicians, who want

year ahead.

access to patient records. We are also in the planning stages of building a new cancer center. I have to make sure buildings are built in a way that supports how

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

06 | Deaconess Health System

Deaconess Health System

Today’s Patient As the project began, the organization didn’t have any dedicated resources focused in the area of clinical

In November of 2009, Deaconess Health System went live with Epic as its platform for their electronic health record (EHR). This system is used in four hospitals and approximately 20 physician practices. Now the organization is focusing heavily on optimizing the EHR, looking at variations in how it is being used and working to standardize practices across the organization.

Todd Richardson, CIO

“Our focus is to build and move things forward with an intuitive approach,” says Todd Richardson, Chief Information Officer of Deaconess Health System. “In July of 2010 we achieved HIMSS Analytics Stage 6 certification and are now focusing on Stage 7 to be completely paperless.”

informatics. They put together a clinical information systems team and today the organization has about 80 full-time employees within the Information Systems department and about 30 full-time employees in Clinical Informatics. Initially the hospital relied heavily on consultants to fill specific areas of expertise while internal staff were developed. Now they are working

ITA ITA offers a complete array of implementation, upgrade, and support services spanning your entire EPIC® Solution. Our consultants are EPIC® certified with real world experience implementing EPIC® in a variety of healthcare settings. ITA provides our clients with highly skilled individuals possessing expertise in building and supporting your EPIC® solutions.

toward replacing a lot of those positions with full-time equivalents on staff. This should help in cutting costs, as well as put the organization into a position to support the hospital’s information systems long-term.

and readied for ‘Go Live’. We brought in a number of

“Being in more of a rural area, it can be a little

consultants to take over responsibility for supporting

more difficult to hire staff with the specific level of

our ‘Legacy Systems’ while our staff focused on Epic.

expertise we need,” says Richardson. “We focused

We are now moving forward with the replacement of

a lot of effort in getting our staff trained and ‘Certi-

these consultants and getting back to a ‘Business As

fied’ on the Epic systems as we prepared our build

Usual’ approach to supporting the organization. HCE EXCHANGE MAGAZINE

Real Issues : Real Solutions

“I think the biggest key to being a successful CIO is really understanding and having a great relationship with my collegues on the operational side of our business.” ones knowing what it can and can’t do and how far we can push it. I want to be out there because they [the clinicians] are going to bring it in and want to use it... We’ve got to be prepared.” “That being said, there is infrastructure to consider and costs that go along with it. We’ve also got to look at the security side of new technology to make sure that we are doing the right things. Educating the organization on the implications of technology is a huge part of the job.”

The Role of a Healthcare Chief Information Officer

and pushing our department to employ solutions that

implications of such technology and what is it going

take into account the needs of the users. We have to

to take to support it? As these systems become more

Richardson sees the role of Chief Information Officer

continue to push the technology to deliver efficient

and more integrated, it becomes more about all of

as having evolved quite a bit. “As we see technology

systems for our users and minimize the hurdles that

us working together as a team to understand the is-

become more invasive in our industry and throughout

can often be presented.”

sues and bring about changes to the system in a very

In order to ease the burden on his technical call

our facilities, we are being forced to come up with

structured and methodical manner to avoid unwanted

new and innovative ways of supporting the IT systems.

center, for instance, and meeting the needs of a 5,000

surprises. It’s not us versus them…It’s truly we. Be-

More and more we are asking users to take a first

person organization, Richardson works to identify su-

tween my technical staff, the operational staff and the

level of support in troubleshooting things from PC

per users in all departments and getting them trained

vendor—we have to come up with a solution.”

issues to providing end-user support for applications.

to answer some of the basic questions. “They are the

Without this sea-change in how we deal with technol-

first line of defense,” says Richardson. “It may be as

of CIO as looking at what’s lurking over the horizon

ogy in our workplace, the IT departments will need to

simple as seeing that a mouse is unplugged or simply

and seeing how he can perhaps leverage new technol-

continue to expand in numbers to provide the level of

rebooting a device may resolve the issue.”

ogy. “Things like the iPads and iPhones,” he says. “We

“I think my role as a CIO fundamentally changes

support that is required in today’s health system. As

Richardson sees another responsibility to the role

need to get out and do the proof of concept. Under-

the CIO, I find myself more involved in the fully under-

as we bring these systems into our organization. It’s

stand what works and what doesn’t and be proactive

standing the issues from an Operations perspective

about continually educating the organization on the

in introducing it to our organization. We need to be the

Keys to Success “I think the biggest key to being a successful CIO is really understanding and having a great relationship with my collegues on the operational side of our business,” says Richardson. “Our industry is healthcare, not technology. While we are the technology arm of our business, it’s not about us. It really is about the operations and the strategic direction of the organization as a whole,” Richardson says. “We have to understand our operations from a healthcare perspective first,” he says. “Then let me build a technology plan to support that. We’re a support service, we’re not the starters. If you don’t have that customer service approach and understand where you fit in the organization, you’re doomed.” by T.M. Simmons

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

“Patients love the attitude our physicians have.”

Attracting care providers Joyce said when his company attends conventions, phy-

OBs, but for various reasons, suddenly ended up with

sicians will be lined up at their booth to find out more

only two. It was nearly impossible for two physicians to

about Delphi’s opportunities.

take call 24 hours a day. Delphi came in to fill the gap,

“They are fascinated with this new service,” he said.

and the hospital was able to recruit new physicians over

“We are attractive to physicians because we take the

the next few years. Once the hospital had seven physi-

business of providing care off their shoulders and let

cians, they were able to take call again and function on

them focus on practicing medicine. We provide malprac-

their own.

tice insurance, negotiate the contract with the hospital and provide billing and collections. They generally work 12 to 14 days a month, as opposed to 20 in private practice, and they make the same income.” This work environment can allow some physicians to extend their careers. Joyce said as some physicians get closer to retirement, they “get tired of the rat race,” but

Delphi is especially advantageous to hospitals that need assistance with filling call hours. “Our obstetricians are always in the hospital,” Joyce said. “We are not at home waiting on a beeper call. We have delivered 10,000 babies and never had a malpractice suit.”

at Delphi, they can practice medicine a few more years

Saving hospitals money

and not be burdened with running a business. He also

Joyce said one major challenge Delphi faces is when

said this shows through in Delphi’s physicians’ attitudes

hospitals assume the services are too expensive. How-

toward patients.

ever, he stresses that he can save hospitals money.

“Patients love the attitude our physicians have,” he said. “Their joy of practicing medicine really shows.”

07 | Delphi Healthcare Partners

works is an early contract for OBs. A hospital had seven

“Our first contract, back in 2004, was for intensivists at a hospital in Ohio,” Joyce said. “I estimated that the hospital would save $4.3 million in the first year. The

Helping hospitals in a bind Delphi signs three-year contracts with hospitals in need of providing specialists in one or more of their four specialty areas. One example he gave of how the service

administrator called me at the end of the first year and said they saved $4.8 million. “ One reason the intensivist service can save money is that hospitals only get paid for an average stay of five days in the ICU. However, a physician can get paid to see a patient in the ICU for as long as they are in the ICU. With Delphi’s intensivists working full-time in the hospi-

Delphi Healthcare Partners

tal, they are able to help the hospital reduce the average

more contracts. He said the organization is adding

length of stay.

resources in sales, risk management, marketing

Other models have a slightly different set-up. For example, Delphi’s orthopedic services set up an office

The physician practice environment in the United States is changing. Most specialties face a physician shortage. The average physician age is increasing, and many who are nearing retirement are looking to reduce their call hours. Private practice physicians face increased administrative pressure with looming healthcare reform and reimbursement changes. These factors have created a unique environment and need for the services of companies such as Delphi Healthcare Partners.

David Joyce, President and CEO

Delphi is a contract physician staffing and management company. David Joyce, President and Chief Executive Officer, said the company contracts with about 400 physicians, with around 200 working full time, and nearly 50 healthcare professionals including nurses and technicians. Delphi contracts with hospitals that are facing a shortage of physicians for numerous reasons to provide specialty services in four areas--obstetrics, general surgery, orthopedics and intensivists. The organization’s primary clients are hospitals with more than 150 beds.

and quality. “We continue to get more sophisticated. As

environment with nurses and staff to be able to continue

hospital expectations go up, so too does our need

follow-up care for patients.

for medical directors to monitor our physicians and

Looking toward the future Delphi Healthcare Partners was started in 2004 and

ensure we are providing what the hospitals need and want,” he said. As with all healthcare organizations, Delphi

has grown to have contracts with 45 hospitals. Several

is watching healthcare reform and how it affects

of their contracted hospitals are using Delphi in two or

hospitals. All contracts added, so far, in 2011 have

more specialties. “At a hospital in California, we have

a physician shortage in one or more specialties

seven programs that account for 65 percent of all hospi-

and are unable to recruit quickly enough to provide

tal admissions,” said Joyce.

effective care. The physician shortage is likely to

Originally, Joyce said their services were used to provide care for indigent patients because the specialists were becoming reluctant to care for this patient population. “Now, two-thirds of our contracts are also

get worse, and Delphi is poised to help solve the problem that will create. By Patricia Chaney

taking care of paying patients,” Joyce said. “We are at hospitals where they just don’t have enough specialists.“ Joyce expects Delphi to continue growing and adding HCE EXCHANGE MAGAZINE

Real Issues : Real Solutions

Improved patient and MD satisfaction scores One way Dennard said the hospital has improved its

with the open-heart project. LEED certification provides

image in the community is by making a concerted ef-

third-party verification that a building project is environ-

fort to improve patient satisfaction scores and physi-

mentally responsible.

cian satisfaction. “We have taken our facility from the third percentile in outpatient satisfaction to the 99th percentile,” Dennard said. Patient satisfaction in ambulatory care has also improved. Dennard touts accountability and communication

improved MRI capabilities and a PET/CT unit. That facility

patients, focusing on physicians,” he said. The hospi-

a new women’s breast center with screening and diag-

tal focused on physicians as well as patients, believing

nostic care under one roof. “Our focus in the women’s center is providing well-

relate to more satisfied patients. That has proven to

ness and prevention services in a spa-like atmosphere,”

be true.

he said.

ability to improve scores. “We sit around a table and

Staying flexible

make a commitment of what we’ll do for the next

Healthcare reform is a concern among all healthcare

week that will enhance the patient’s experience at our

organizations in the United States. Gwinnett Medical is

facility,” he said. “Then we come back together and

looking at ways to improve efficiency and prepare

give a report on those activities. We hold each other

for reform. “We are not waiting until the last minute to respond,” Dennard said. “We are evaluating supply chain management, labor efficiencies and non-patient revenue. How

To remain competitive, Gwinnett Medical Center has

we can enhance the experience for patients, physicians

also found a need to expand services. Gwinnett County

and associates? We are also asking questions about

is the largest county in the United States without an

where we fit in with an accountable care organization,

open-heart surgery program. The hospital obtained a

and how will all this affect Gwinnett County.”

Certificate of Need for an open-heart program and re-

Dennard is looking to the future and is encouraged

cently began building a 40,000 square foot west wing

by the improvements Gwinnett Medical has made in his

onto their main building. The new wing will house a

time with the hospital.

three-story facility that includes two open-heart sur-

Jay Dennard, COO

clude building an outpatient imaging facility. It will have

to imaging services, Gwinnett Medical Center is building

Expanding services

“This is a competitive healthcare market from a provider standpoint,” Dennard said. “We know there are a lot of patients that leave our community to receive care in Atlanta, so we need to make sure we’re telling our message in the right way so that people will choose us first.”

Other construction projects to enhance services in-

enal work at having a cultural revolution, focusing on

accountable.”

Jay Dennard is Chief Operating Officer for Gwinnett Medical Center-Lawrenceville, the flagship facility for the health system. Gwinnett Medical Center also has an 81-bed hospital in Duluth, as well as a rehabilitation facility, an extended care center, a women’s pavilion and imaging centers.

ner. This will set the stage for what we do in the future.”

is expected to be operational by Spring 2011. In addition

Employees and leaders also stepped up account-

In a county on the outskirts of Atlanta, Georgia, Gwinnett Medical Center faces an extremely competitive healthcare environment. During the past few years the hospital systemhas put in a lot of hard work to improve patient and physician satisfaction as well as expand the services is provides to its community.

“We didn’t want to just be building buildings,” he said. “We want to ensure we are a good community part-

as keys to this turnaround. “We have done phenom-

that high physician and employee satisfaction would

Gwinnett Medical Center

08 | Gwinnett Medical Center

gery suites and two cardiac catheterization labs.

“With all the challenges out there in the market, Gwinnett Medical Center is poised for growth to meet

In building projects, Gwinnett is striving to build

needs of our community,” he said. “It’s exciting to be

facilities that are not only patient-friendly but envi-

here. We are seeing great strides in how our patients

ronmentally friendly as well. The hospital opened a

feel about us and how our associates and physicians feel

new 155-bed tower a year ago, with patient rooms that

about us. I feel very fortunate to truly be part of cultural

were about 50 percent larger.

revolution on campus.”

“We wanted to ensure we had continuity of care in process and design in the west wing expansion,”

By Patricia Chaney

Dennard said. “We make sure we have the patient at the center of development, as well as work with our physicians and staff because they have to work in the new facility.” Dennard said the hospital is focusing on green ini-

INDUSTRY PARTNERS McKesson Provider Technologies www.mckesson.com

tiatives and sustainability, going for LEED certification

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

09 | Huelat Parimucha, Ltd

Huelat Parimucha, Ltd The architectural and design firm of Huelat Parimucha began twenty years ago with the mission of improving patient outcomes—physically, spiritually and emotionally—through the creation of healing environments. The firm is based in Alexandria, Virginia, and has built a reputation locally, nationally and internationally over the past two decades. Among their clients are Potomac Hospital, Washington Hospital Center, George Washington University Medical Faculty Associates and the Veteran’s Administration (VA).

Barbara Huelat, President

“Our strongest level of expertise is in the hospital environment itself, in acute care,” Barbara Huelat, President, said. “We complete the interior design, the interior architecture and the architecture itself. We have a very narrow focus, even for a healthcare design firm, which focuses on the patients themselves and the people that use the facility, including staff.”

Healing the Whole Person

ing larger, little things fall through the cracks; little

Huelat Parimucha is a Planetree Certified design

things being the simple things, a thought here or

firm, and a member of Planetree’s Visionary Design

there that just wasn’t passed on. That’s our biggest

Network. Planetree is a non-profit organization which

challenge right now, staying connected on a personal

began in the 1970s as a grassroots movement dedi-

level with all the projects, all the team players and all

cated to advancing patient-centered care. It takes its

the consultants.” Because they are starting with such a strong core

name from the favored teaching site of the father of western medicine, Hippocrates, who was said to have

team of individuals, however, Huelat is optimistic that

taught his students in ancient Greece from beneath

they will see the firm double in size within the next

the shade of the Planetree.

three years or so.

Adding the VA as one of their most recent clients,

“The people we have are intimately involved and

Huelat said the focus of healthcare in this nation

passionate about what we do,” Huelat said. “Keeping

“You think of these real people and start to ask what

reform as we think we can make a big difference

is about to change on a large scale. “The VA is now

people in the loop and in tune with the projects—that’s

they are looking for in their lives,” Huelat said. “We

there. When you are really dealing with what is best

working toward becoming Planetree certified. As the

really important—and keeping people in the link with

design from that perspective…to help them have better

for the patient, it isn’t always what’s being built today,

largest provider of healthcare in the world, if they go

our staff meetings and our reviews and keeping every-

outcomes, better relationships and to get on with their

and since our focus is what’s best for the patient, if we

Planetree, we are going to see a different quality of

body in tune with the project is really important. That

life. The environment plays a major role in that.”

can provide some insight into what we’ve learned all

care focus everywhere.”

has been our success. We have been able to meet

Growing a Healthcare Design Firm The addition of larger clients such as the VA, of course, means that this relatively small firm of eight

and exceed our client’s expectations on all projects. I

because the missions of the two organizations are well

have to acknowledge that our people who work on the

in line to support each other. They do Planetree evalua-

projects are really committed; it’s not just a job, it’s a

tions for other facilities. They make design recommen-

life experience.”

dations. As their part of advancing the mission of both

Improving the Patient Experience

individuals will grow. “Getting and keeping good people who are both

Huelat Parimucha partners closely with Planetree

organizations, they speak and present about designing for the patient experience at every opportunity. “We are very proactive in sharing what we’ve

talented, as well as being committed to the patient-

Each job Huelat Parimucha takes on begins with a

learned in the healthcare environment with others to

centered philosophy has always been a challenge,”

study of the individuals who are being served. Where

make a better healthcare environment,” Huelat said.

Huelat said. “Now that we are growing larger, we are

are they from? What is their income? What has

seeing the new challenge is how to keep connected.

brought them to this place in their lives and to this

are going to be launched across the country,” Huelat

When you are a small firm, it’s easy to stay connected

particular healthcare facility? Once the patient experi-

added. “We’d like it to be part of these new standards

with all the projects. Through the process of grow-

ence is understood, design can begin.

for initiatives that are growing up out of the healthcare

these years, we can help set a new standard.” By T.M. Simmons

INDUSTRY PARTNERS Avio Galleries www.avioart.com

“We’re looking at healthcare reform initiatives that

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

10 | Jefferson County Health Center

Engaging the community and staff Fairfield is a town of about 9,000 residents in rural Iowa. Fairfield is also home to the Maharishi University of Management (MUM), which attracts students from more than 80 countries. Numerous businesses in the community are also associated with the university. Following the lead of many of the new buildings on the MUM campus, which incorporate the principles of Vedic architecture, east entrances were chosen for the new health center. “Now our front door and even our emergency department, which is on the north side of the building, have entrances that face east.” In addition to the MUM and Fairfield communities, Jefferson involved all staff in the design, making the final result extremely functional for staff and patients. Nursing units are arranged so there is a pod outside every two patient rooms with a computer, medication and supplies. Each room has a patient lift that moves in all directions and can lift patients anywhere around the room. Being a critical-access facility with limited staff, employees need to be multipurpose, which also affected design.

“Our staff needs to be able to work in more than one

Cardin said she credits the success of Jefferson to the

unit,” Cardin said. “We made all nursing units adja-

employees. Her key to success as an administrator

cent to each other, so if one gets busy, we can easily

has been communication--communication with the

pull from one to another.”

community, physicians, nurses, leadership and staff

Incorporating green initiatives In 2008, Fairfield developed a “Go Green” plan to encourage green business practices; the MUM community also wanted to see more sustainable

at every step of the project. Jefferson County Health Center has shown all stakeholders that it listens by incorporating their values and needs into the health services it offers. by Patricia Chaney

features. The replacement facility was a pilot project for the Green Guide for Healthcare, a best practices guide for healthy and sustainable building practices. Jefferson implemented many sustainable features including low VOC interior finishes and paints; tiles using significant recycled content; low-maintenance grass, eliminating the need for irrigation; and

INDUSTRY PARTNERS Hammel, Green and Abrahamson, Inc. Architects / Engineers / Planners www.hga.com

broad expanses of windows, reducing reliance on artificial lighting. The hospital is also wireless and is working toward a complete electronic health record. The health center started CPOE in 2005, helping its vendor improve their system.

Building the organization’s values

Jefferson County Health Center

Cardin has been with the organization for 12 years, but took over as Chief Administrator about two years ago. When she began, the hospital had previously not had organizational goals or a recent strategic plan. She also had work to do to improve the relationship

Starting with the oldest hospital west of the Mississippi River, Jefferson County Health Center underwent a large project a few years ago to build a replacement facility. Located in Fairfield, Iowa, the health center faced unique challenges with a diverse community and a difficult facility location.

between administration and physicians. “My first order of business was to establish organizational goals,” she said. “We developed these with input from medical staff and the Board of Trustees. Then we rolled them down to departments and

Deb Cardin, CEO and Chief Administrator

The original hospital facility was landlocked in a residential area, leading to the decision to build an entirely new facility on the edge of the Fairfield community. The new facility opened in 2009 and features many natural elements conducive to healing as well as to green initiatives. The project included the 120,000 square foot, 25-bed critical-access hospital, an attached medical office building and a 10-bed dialysis unit on campus. “Our new hospital sits in a tranquil setting at the edge of the community flanked by three recently restored barns,” said Deb Cardin, Chief Executive Officer and Chief Administrator. “The campus has a courtyard garden, walking trails and a pond. Patient rooms have views of the barns, adjacent meadows and the pond.”

employees. “We have seen progress, including a 31 percent reduction in adverse events, increases in patient, employee and physician satisfaction scores. We recently completed a physician satisfaction survey, developed with help from the physicians to comprise every department, and our overall score was a 4.5 out of 5. We just had 97 percent overall patient satisfaction scores in both the emergency department and inpatient.”

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

11 | National Naval Medical Center

National Naval Medical Center In July 2008, President George W. Bush, Defense Department officials and Wounded Warriors broke ground on the future Walter Reed National Military Medical Center Bethesda. Since then, the National Naval Medical Center (NNMC) and Naval Facilities Engineering Command have been diligently working to expand facilities to integrate NNMC and Walter Reed Army Medical Center (WRAMC) at the NNMC in Bethesda.

Capt. Steve Hamer, Commanding officer

design has the ability to change to future needs and have the flexibility for different utility down the road.” One example of the flexibility is five exam rooms

Capt. Steve Hamer, commanding officer, Officer-In-Charge of Construction Bethesda, outlined the numerous projects going on at the NNMC campus. The main projects are a 515,000 square foot outpatient facility and a 162,000 square foot inpatient facility, which includes a new emergency department and intensive care unit. Both of these projects have been completed. In addition, about 390,000 square feet in the existing hospital are being renovated. Other projects include a new facility to house wounded warriors, a dining hall, and administrative offices; a complex with administrative offices and a fitness center to accommodate the increase in personnel; as well as a multi-use parking garage. Capt. Hamer oversees all construction and at NNMC and Naval Support Activity Bethesda.

in the emergency room can become additional trauma rooms as needed. The new facility also has offices and exam rooms that are interchangeable.

Overcoming challenges The primary challenge is the size and complexity of this project and it is on a tight schedule to meet the Base Realignment and Closure (BRAC) deadline of September 2011. Capt. Hamer credits the designbuild approach taken with contractors to allow for the ability to react to changes in the schedule, medical

“You build a building with the intention that it’s going to last 50 years or more.” Capt. Hamer said the project has been going well so far, with many phases complete with minimal interruption to current operations as possible. He said the close communication between NNMC, WRAMC, Joint Task Force CapMed and OICC has been key. “The hospital, their staff and personnel assigned to oversee the transition have a done a great job helping us understand what their needs are and will be,” he said. “We incorporate those needs into our design and schedule.” JTF CapMed leads the way for the efficient consolidation and realignment of military healthcare in the national capital region. The JTF is working with the hospitals and OICC on this project to ensure the quality of patient care and construction are met.

technology, or facility needs as they happen. “The design staff is already on board throughout

Design elements for sustainability and flexibility The medical facility’s new construction achieved a LEED gold certification on the buildings A and B projects. The OICC team is working to include sustainability features that achieve at least the LEED silver certification standard. To do this the team focuses on high-efficiency lighting, heat recovery, recycling construction waste, landscaping that doesn’t require irrigation and other features. Capt. Hamer said the construction team is building flexibility into the design, by having areas designated as future use spaces. He also said they are outfitting some rooms to have uses that go beyond their original intent. “You build a building with the intention that it’s going to last 50 years or more,” he said. “Our approach to patient care in that time frame can change. Our

the project and helps us have rapid development and implementation of changes in the field,” he said. “When you have projects this size it is hard to antici-

“The design-build concept allows you to work out those issues without losing too much time on the overall schedule, rather than having to resolve all issues before you execute construction.”

pate all issues within construction. The design-build concept allows you to work out those issues without losing too much time on the overall schedule, rather than having to resolve all issues before you execute construction.” Once complete, the facility will be one of the largest military healthcare facilities in the world.

INDUSTRY PARTNERS The Whiting-Turner Contracting Company www.whiting-turner.com

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

12 | Silver Hill Hospital

Mental Healthcare in a Residential Setting Silver Hill is unique in its physical structure as a hospital that primarily operates out of a home atmosphere. The only structure built specifically for the treatment of mental illness is the one that was added in 1985. The rest are literally homes that have been refurbished, of late, with the positive margin the hos-

Richard Turlington Architects, Inc.

pital has managed to gain since the big-turnaround

Richard Turlington Architects, Inc. is a full-

of the organization was implemented in 2003. The

service architecture and technical consult-

hospital had struggled some in the 1990s. The adjust-

ing firm servicing Connecticut. We have

ment to managed care had taken a toll and revenues

been creating beautiful buildings for more

were down.

than 25 years. Each service we provide is

“We’ve put a lot of resources into renovating the

approached with expert judgment and an

buildings because there was a huge amount of de-

attitude of flexibility. These are the keys to

ferred capital maintenance and capital improvement,”

achieving our primary objective: providing

says Ackerman. “We developed a master plan for the

what the client really wants in the most ef-

facility grounds and buildings and we’re about 80%

ficient way possible.

through with the structural portion of the master plan.

Silver Hill Hospital The history of mental health at Silver Hill Hospital in New Canaan, Connecticut dates back to 1931. Dr. John Millet was a psychoanalyst looking to become part of the New York psychoanalytic movement. The original farmhouse became a six-bed treatment center. Though the conditions treated seem mild compared to the cases the hospital handles today, it marked the hospital as a place where people go to recover and get a grip on their lives.

Dr. Sigurd H. Ackerman, President and Medical Director

The original house remains and is now one of 12 clinical facilities on 43 acres of land. It currently operates 115 beds. Approximately 50 of those are traditional, inpatient beds. The rest are long-term, residential treatment beds where the minimum stay is four weeks or more. “We now treat a huge range of patients,” says Dr. Sigurd H. Ackerman, President and Medical Director. “Almost all of our patients are covered by commercial insurance on the inpatient units. In order to get insurance authorization, all the patients admitted here are quite ill or they wouldn’t be covered by their insurance policy. There’s been quite a transition in the past 80 years. Between 1931 and now, in the kind of hospital we are has more or less exactly corresponded to advances in psychiatry.”

244 Maple Street New Haven CT 06511 P 203.772.2459 F 203.772.2473 info@rt-arch.com

www.richardturlingtonarchitects.com

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

13 | Hamister Group, Inc.

The hospital is very appealing to patients physically. It’s a very nice place to be.” They also upgraded communications and added an electronic medical chart. This began four years ago and today the hospital is completely electronic using the commercial version of the same program that is being used by the Veteran’s Administration. Medsphere’s OpenVista EHR solution makes them essentially paperless. They are still in the process of adding a couple of items, such as prescriptions, but everything is linked ready to go.

Areas of Service The hospital handles a range of specialty services. Their current five residential programs include chemical dependency rehabilitation, a dual disorder program for people with significant psychiatric disorders who also have problems with a chemical dependency, severe personality disorders that result in poor mood and impulse control, schizophrenia and other psychotic disorders, and a special center for treating

That’s how we’ve managed for the last seven years.

adolescent disorders. The latter “may have a whole

That’s how we’ve had a little bit more to plow back

range of different problems but are grouped together

into facility improvement, program development, IT

because they are adolescents,” says Ackerman.

infrastructure and so forth.”

The challenge remains having enough room for

“The thing that I’m most proud of is that the

all patients and meeting the cost. “Especially for a

overall quality of care for patients has improved and

psychiatric hospital in this environment, the inpatient

the patient experience here has improved a lot also,”

programs that we were able to run regularly lose

says Ackerman. “The whole thing is better. We have

money because we want to provide really first rate

11 full-time psychiatrists counting me. Eight of those

care, which means first rate staffing,” says Ackerman.

are double-boarded. They are very experienced. It’s

“The residential programs are, for the most part, not

an unusually proficient group of people.”

covered by insurance, so the revenues from these programs cover the losses for the inpatient program.

Hamister Group, Inc.

“It means we have especially good programs now and can provide excellent patient care.. I’ve been in

The United States is facing an aging population and seeing an increased need for assisted-living and retirement services. For years, the healthcare industry has been trending away from skilled nursing home facilities to assisted-living or independent communities. Residents are joining these communities with higher expectations and higher standards for independence and quality of life. Amenities such as recreation and entertainment, a high-quality dining experience and superior healthcare services are highly sought.

hospitals now for 40 years … and, overall, this is as good as I’ve seen. I’m very proud of that. The facilities are very nice. I’m pleased for that. The patient experience here is great. But the most important

“The whole thing is better.”

statement I can make is that the average patient can expect to improve substantially—and that’s a big thing to say.” By T.M. Simmons

Jack Turesky, President and COO

The Hamister Group, Inc., has been on the forefront of providing quality healthcare, as well as continually increasing its focus on fine dining standards and recreation activities for their community residents.

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

“People evaluate the quality of care and their

properties are not just meeting, but exceeding their

on continual and quality communication with the fam-

satisfaction levels with things they understand and

individual needs. A key focus of our healthcare, hotel

ily to keep them up-to-date and help them understand

are comfortable with, namely food and recreation,”

and company-wide co-worker surveys is to not simply

how their loved ones are doing.”

said Jack Turesky, President and Chief Operating

ask how we can improve our services, but to encour-

Officer. “We have ice cream parlors which are

age the sharing of innovative ideas from those we

reminiscent of the 1950s, movie theaters, billiards

survey. It is also essential we act upon the responses

Maintaining committed coworkers

rooms, libraries and expansive space for a wide

we receive, develop and implement improvement

Maintaining flexibility and a forward-looking, cutting-

range of recreation activities. We also hire culinary-

initiatives.”

edge mentality on continual quality improvement

educated chefs and employ Food Service Directors at

In addition to the fine dining and focus on a wide-

are key to The Hamister Group’s ability to maintain

each of our residences to provide more gourmet-style

range of daily recreation activities, the Hamister

hotel-like, service-based environments in its inpatient

fare and provide a truly fine dining experience for

Group, Inc., also desires to be a cutting-edge health-

assisted-living residences.

our residents.”

care-industry leader.

The Hamister Group, Inc., based in Western New

“Recently, Skype video conferencing was offered

“Our company culture focuses on accessibility, speed and impact,” Turesky said. “All co-workers

York, has three inpatient assisted-living residences

at our healthcare residences to allow all residents

have access to and regular interaction with senior

that also provide memory-care accommodations and

and guests the ability to communicate with family and

management; we are small enough to make quick

“Our turnover rate is down to 57 percent, which is low

total 436 beds. In addition, the company operates a

friends via video locally, nationally and international-

decisions; and all co-workers, no matter their level

for the industry, and we are continually working to

home-health agency and 10 hotels, including Mar-

ly,” Turesky said. “Skype has been the biggest hit. We

within the company or area of business, can make a

improve it.”

riott and Hilton-brand properties. The group recently

educated staff co-workers at our residences and their

significant impact on our organization.”

tested independent-living apartments at Brompton

families to demonstrate the video capabilities. Our

Heights in Williamsville, New York, which was a suc-

sign-up sheets are full every day. The residents love

workers is that each healthcare personal-care aide is

hotel business groups. “We want to continue growing

cessful pilot program. All the amenities and services

using it and are able to see family members’ faces

authorized to spend $25, no questions asked, if they

our healthcare division, as we see our demograph-

of the assisted-living residences were offered to

across the county. Family members and friends can

encounter a problem with a resident or

ics pointing toward more baby boomers looking for

the independent-living residents, with the option to

video call with our residents on special occasions, in-

family member.

assisted living-level healthcare services over skilled

transfer to the assisted-living level of care if needed.

cluding birthdays or holidays; what a wonderful thing

Turesky said the group plans to add independent-liv-

it is to see one of our residents talking and laughing

co-workers the autonomy to make decisions, which

ing apartments to another assisted-living residence.

with a grandchild or even great-grandchild who is

increases the resident and/or guest’s satisfaction as

has a strong focus on succession planning, begin-

across the country.”

well as the co-worker’s own personal satisfaction

ning at the middle-management level and extending

knowing they were able to make a difference and take

to our staff-level co-workers with an emphasis on

ownership of the situation,” he said.

creating further co-worker professional development

Key focus on service excellence

While the fine dining and recreation focus of The Hamister Group’s assisted-living residences provide

“We place a monumental emphasis on resident and

overt benefits to the residents, the company also

guest service excellence,” Turesky said. “Over the

focuses on offering the highest quality healthcare to

past 25 years, we’ve maintained a continual focus on

meet residents’ individual needs.

developing innovative ideas to improve our resident, guest and co-worker satisfaction scores.”

“We recently added a new program called Private

One example he offered of empowering co-

“We want to solve problems quickly and provide

Recently, the group developed and implemented a mentor program for its co-workers.

and working knowledge of their positions may join the

group,” Turesky said. “This allows residents to stay at

program and take on a mentor role for new hires,”

care resident, and co-worker satisfaction is through

our level of assisted-living care a little longer without

Turesky said. “If successfully evaluated by the newly

visibility of the senior management.

incurring additional cost.”

hired co-worker after completion of the program, the

family involvement in the healthcare needs decision-

their time invested in supporting new co-workers and

property locations,” Turesky said. “It’s important to

making process.

helping develop their knowledge of their responsibili-

“Our facility will not consult with a resident’s

tive part of the residence or hotel’s operation. Our

primary or specialty physician without involving the

company surveys healthcare residents and their fam-

resident or primary-care family member,” Turesky

ily members as well as our hotel guests to ensure our

said. “The management and staff have an emphasis

programs. Our company is focused on developing our leaders of tomorrow.”

INDUSTRY PARTNERS Lawley Insurance www.lawleyinsurance.com

mentors receive a financial bonus as an incentive for

me or our CEO by name and see us regularly at the our leadership to be visible and to be seen as an ac-

“In addition,” Turesky advised, “our company also

“Co-workers employed for a year or more with our

Duty Companion within our healthcare business

He also said the staff maintains both resident and

nursing,”

company who have exhibited strong leadership traits

A significant way to improve hotel guest, health-

“Co-workers and even healthcare residents know

Turesky said he expects The Hamister Group, Inc. to continue expanding both its healthcare and

ties. We have found this mentor program has also improved our co-worker satisfaction.” “This investment in the mentor program was a fair amount, but it has been paying off,” he added.

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

14 | Winchester Gardens

Meeting the needs of current residents in design and programming In 1996, Winchester Gardens underwent renovation to become its current continuing-care retirement community and has continued to undergo design changes

In addition to functional design, incoming residents want flexibility and engaging programming. Rogerino said the organization has been working to offer more dining options and more activities. â&#x20AC;&#x153;Residents want to be active and have participatory recreation programs,â&#x20AC;? he said. â&#x20AC;&#x153;They enjoy taking

to meet the needs of its residents. Most units are anywhere from 750 square feet to 2000 square feet. â&#x20AC;&#x153;Our residents are coming in at a point where they need a functional environment,â&#x20AC;? Rogerino said.

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â&#x20AC;&#x153;Residents want appropriate storage and lighting,

Providing Residents with a rewarding way of

ovens they donâ&#x20AC;&#x2122;t have to bend down to reach, a micro-

life means facing challenges every day. At

wave that is not too high, and functional, yet spacious

Sodexo Senior Living, we support your mis-

closets.â&#x20AC;?

sion by leveraging our resources with the

Most recently, Winchester Gardens renovated

deliver independence and control to resi-

said maintaining the aesthetics and functionality of the

dents in an atmosphere of genuine respect.

units is an ongoing priority for the organization.

From dining and nutrition programs to

â&#x20AC;&#x153;We continually reinvest about $2 million every

Winchester Gardens

building services, we put the utmost atten-

year into the basics â&#x20AC;&#x201C; environmental issues, redeco-

tion into ensuring residents are the heart of

rating, upgrading, renovating,â&#x20AC;? he said.

everything we do.

6 Ă&#x20AC; Ă&#x20AC; Ă&#x20AC; 6 Ă&#x20AC; Â&#x201D; 6 Ăˇ Â&#x201D;

As the large number of baby boomers begins looking toward retirement, retirement communities need to reposition themselves to meet the expectations of this new group of residents. Winchester Gardens, located in Maplewood, New Jersey, understands this need perhaps better than most.

expertise of your communityâ&#x20AC;&#x2122;s Together we

units to provide these features to residents. Rogerino

6 Ăˇ A Ă&#x20AC; 5 Ăˇ Â&#x201D; . 6 Ă&#x20AC; 6Ăˇ Ă&#x20AC; Â&#x201D; . Ă&#x20AC; Â&#x2019; 6 Ă&#x20AC; Â&#x201D;

A better day places residents at the heart of everything we do. Thereâ&#x20AC;&#x2122;s no place like home, but you can come closer to creating that experience for your residents. From the food they eat to the air they breathe; from the design

Greg Rogerino, President and CEO

Begun in 1927 as a not-for-profit retirement community for â&#x20AC;&#x153;aged and respected bachelors and gentlemen,â&#x20AC;? Winchester Gardens has undergone drastic changes to become a continuing-care retirement community. The retirement communityâ&#x20AC;&#x2122;s original developers focused on architecture and landscaping as part of a residential design. The current residence maintains the beauty and historic architecture in its 202 independent living units and 115 health-services units. Winchester Gardens also has 40 villas. â&#x20AC;&#x153;We have repositioned many times and remain successful,â&#x20AC;? Greg Rogerino, President and Chief Executive Officer, said. â&#x20AC;&#x153;We offer a continuum of care, and keep our designs flexible and appropriate for the current market.â&#x20AC;?

of the space they live in to the people who help them have a better day. Thatâ&#x20AC;&#x2122;s why

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HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

15 | NHS Human Services

a bus into New York City, seeing a play, exercising. A

decision to leave their home and move into a skilled-

lot of our residents have personal trainers.”

nursing or assisted-living facility,” he said.

Providing quality services

two keys to maintaining resident satisfaction.

In addition to making residents feel comfortable and

Communication and appropriate programming are “We don’t want anyone to come in and think

engaged, providing quality service throughout the

they are going to be moved through the continuum

continuum of care is also essential for Winchester

arbitrarily or without input,” he said. Rogerino noted

Gardens. Some residents are reluctant to enter the

that residents are entering the community at older

community, especially in today’s housing market.

ages, and one challenge has been to ensure that the

Most people need to sell their homes before

independent living units and programming meets the

moving in.

physical needs of these residents.

“I always hear people say they don’t want to leave

“I think we have been ahead of the curve in de-

their homes, but within about two weeks of moving in

signing homes that are appropriate for people with

they seem to be extremely happy and comfortable,”

physical limitations,” Rogerino said.

Rogerino said. “They seem to most enjoy the connections they build with other residents.” The continuing care model also offers security to

Winchester Gardens maintains high standards for quality care and is accredited by CARF-CCAC. “You cannot lose focus on providing good quality

residents, and Rogerino said keeping the residents

care,” Rogerino said. “It’s not something you say ‘I’ve

involved in their care is critical. Someone moving into

done it.’ It’s a relentless issue.”

Winchester Gardens can start in independent living and move into additional care up to skilled nursing or an Alzheimer’s unit as their needs change. “Our residents will never be in a situation where there is an emergency and they have to make a quick

NHS Human Services The history of NHS Human Services dates back to the 1960s when President John F. Kennedy began providing federal funding for community health centers. As the Northwest Center, the organization was one of the first three mental health service units in Philadelphia, Pennsylvania. Today they operate 670 facilities in seven states. They are one of the largest non-profit providers of human services. These services include programs in the areas of mental health, addictive diseases, intellectual and developmental disabilities, juvenile justice, autism, education and foster care.

Joseph Rocks, CEO

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

requirements of the child with autism. NHS currently is running 18 day programs for autistic children.

Then the child grows old enough for schooling.

HEALTHCARE

FINANCING.

â&#x20AC;&#x153;In too many instancesâ&#x20AC;Ś the public school systems, as much as they try, just donâ&#x20AC;&#x2122;t have the ability to give [the autistic student] in a normal classroom what they need,â&#x20AC;? Rocks said. NHS now runs 10 specialized, private autism schools.

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â&#x20AC;&#x153;It is not extraordinary for us to be waitlisted in the opening of a school by the time we open the door to the first student,â&#x20AC;? Rocks added. â&#x20AC;&#x153;We will continue to

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grow in this area.â&#x20AC;? But what happens to the kids with autism as they become adults? Until recently, there was limited programming for these individuals beyond early child-

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hood, so NHS began pilot programs to fill this need. By specializing in multiple areas, even when those areas seem to be so diversely separate in scope and need, they are able to further the continuum of care. Rocks shared the following example: NHS has historically worked with individuals who have needed residential services after states have shut down their

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large state hospitals. â&#x20AC;&#x153;One of our first programs had six adult men. I believe the age range was 40 to 60, and they had a lifetime of being institutionalized. The state institution believed that these guys were men-

Diversification and Specialization of Services

tally retarded, and the fact is they were autistic. When they came to us they had very little ability to articulate â&#x20AC;Ś they had no behavioral skills at all â&#x20AC;Ś a year in our

At first glance, NHS seems to provide a widely diverse

program, and every one of those guys had the ability to

slate of services. There is a philosophy behind their

articulate. They now live this remarkably recaptured

method, however.

life that should have been theirs for decades.â&#x20AC;?

â&#x20AC;&#x153;We look at the continuum of care in every single service line,â&#x20AC;? Joseph Rocks, CEO, said. For instance, NHS currently has about 2,500 kids

â&#x20AC;&#x153;Thatâ&#x20AC;&#x2122;s the reward of the initial impression of diversification,â&#x20AC;? Rocks said. â&#x20AC;&#x153;We are diversified, but NHS is very explicit about our commitment to these

on the autism spectrum in their care. They begin by

two methods of growthâ&#x20AC;&#x201D;diversification and special-

working with the autistic child at a young age, as do

izationâ&#x20AC;&#x201D;in order to provide a continuum of care.â&#x20AC;?

most providers in the country. â&#x20AC;&#x153;For those who have to work with families of

Growing by Reputation

persons with autism, what is not recognized widely

As a non-profit organization, NHS has limited re-

enough is that the entire family is affected. For the

sources for marketing. â&#x20AC;&#x153;Our growth into newer states

siblings of the child with autism, and certainly for the

comes pretty predictably because someone knows

parents, you end up with your life and needs centered

that we specialize, and they have a need that they

on the attention of that one child,â&#x20AC;? Rocks said.

donâ&#x20AC;&#x2122;t find in their own state or their own provider

One answer they provide is day programs which allow families to return to some semblance of routine that may not be possible due to the constant care

community,â&#x20AC;? Rocks said. They were selected to provide services in New Orleans in the aftermath of Hurricane Katrina because

of their reputation for providing community-based services in Pennsylvania. The infrastructure in New

5HGXFH WRWDO FRVW RI RZQHUVKLS 6LPSOLI\ DFTXLVLWLRQ DQG GLVSRVDO

Orleans had been decimated, and the city needed new models of care for the chronically mentally ill homeless because traditional forms of care were still not func-

/HDVH ZLWK &6,

tioning. â&#x20AC;&#x153;Once you excel and once people see the quality of care and your ability, the next question becomes, â&#x20AC;&#x2DC;What else do you guys do?â&#x20AC;&#x2122; In the last several months we have tripled our business in Louisiana,â&#x20AC;? Rocks said.

&6, KDV EHHQ VROYLQJ WHFKQRORJ\ KHDGDFKHV ZLWK IOH[LEOH OHDVLQJ VROXWLRQV QHDUO\ \HDUV

â&#x20AC;&#x153;They want us to do more and more. Theyâ&#x20AC;&#x2122;ve currently

CS I LEAS ING

got us at the table talking about an autism school. That

the power of experience

is how we market.â&#x20AC;?

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Becoming an Industry Leader in Technology NHS is about $10 million into a technology investment that Rocks expects to result in the organization becoming the IT leader for its industry. They have heavily invested in Kronos to develop their state-of-the-art platform for human-resource management. They are working with NetSmart to develop an electronic client record, and they use a financial platform called Great Plains for their general ledger. This sets NHS up to be a specialist in another service area, as well.

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There is no way they have the access to capital, nor do they have the cash on hand to make that technology. Some of these providers are well-managed and they have a terrific mission,â&#x20AC;? Rocks said.

BEFORE

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HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

16 | Coulee Medical Center

Coulee Medical Center sions. Sometimes this goes over well and sometimes it doesn’t.”

As hospitals expand and make large investments in new facilities, the expectations for care also expand. In rural eastern Washington State, a 25-bed critical-access hospital has recently moved into a new facility and is creating a culture that fully supports its growing vision. Coulee Medical Center (CMC) plans to be “a regional medical center that is the best place for care and the best place to work locally,” said Chief Executive Officer Scott Graham.

Scott Graham, CEO

The hospital serves five counties, covering about a 50-mile radius. CMC moved into its new facility in early 2011 and has all-new equipment in its emergency room, two OR suites, a labor and delivery unit, and observation rooms. The 66,000-square-foot facility also houses an outpatient medical clinic. With a larger facility, the hospital invested in new CT machines, mammography, telemetry and anesthesia machines.

Graham also emphasized respect as a key value for working at CMC. Respect applies in communication at all levels of the organization, and disrespect is not tolerated. “I think the emphasis on respect has had positive effects,” he said. “We have seen improved recruitment and retention for nurses and physicians.” Professionalism is another key aspect to the success of the organization. To Graham, this means putting the patients’ needs first, and putting the organization’s needs ahead of individual needs. Since becoming CEO in March 2010, Graham, along with the hospital board, also implemented a dress code. “We behave ourselves in a way that distinguishes

“We replaced our equipment from top to bottom,” Graham said. “We knew this investment was going to have to last us a while, so we tried to ensure we have equipment that will last us five to 10 years.”

who works in this organization,” he said. “A dress code is part of that. When you dress professionally, you act professionally.” Another aspect to improving the environment has been the move to becoming a tobacco-free facility in the fall of 2010. Graham said the response from the

Going paperless

Driven by mission and values

community has been overwhelmingly positive.

In preparation for the transition to a new facility, CMC

Graham said all executives, physicians and staff are

began an initiative to go paperless in the next several

engaged and invested in the health of the organization.

years. All paper documents were scanned prior to the

Part of this is through an emphasis on the hospital’s

Focus on finances and the future

move and now live on a server rather than in

values—integrity, compassion, respect, competence,

large files.

professionalism and financial viability. The goals are

In recognition of its efforts, CMC achieved Stage 6

manifested throughout the hospital and are all a part

designation from the HIMSS Analytics EMR Adoption

of meeting the vision of becoming the best place for

Model, putting it one step away from becoming a fully

care and to work.

paperless hospital. CMC is one of only six critical-

“Integrity is at the top, and we strive to meet that

access hospitals in the country to have reached

not just in traditional terms of keeping the books

that level.

clean, but also in avoiding the over-promising and

“We have a commitment from leadership and

under-delivering syndrome,” Graham said. “We do

medical staff to be as advanced as possible in elec-

everything we can to follow through on what we say.

tronic health records and becoming streamlined,”

We also work together to operationalize and commu-

Graham said.

nicate change. We aren’t afraid to make tough deci-

integrity, compassion, respect, competence, professionalism and financial viability

As with any healthcare organization, financial viability is also a huge concern for CMC. Graham said the organization is doing well financially. With many federal employees in the region, the hospital enjoys a favorable payer mix compared with other community hospitals. But Graham has been implementing changes to become more proactive with finances. “When I first started, the way the hospital determined viability was looking at a balance sheet at the end of the month,” he said. “We are developing a dashboard that will have key metrics available every

CMC is undergoing cultural changes and shifts not just physically from the move to a new facility, but also in its strategic vision, becoming more streamlined and electronic. Graham looks forward to the future and the effects of these current initiatives. The executive team is only a couple years old and committed to doing everything it can to become the best place for care and work. by Patricia Chaney

day for each manager and executive in the organization. There will be a finger on the pulse of the health of the organization rather than a retrospective look at balance sheets.” The dashboard will include measures such as employees per occupied beds, average daily census and productivity. It will be electronically pushed to leadership on a daily, weekly, monthly and quarterly basis.

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

17 | Tampa General Hospital

Growth and expansion To continue meeting the needs of its residents, Tampa

“We have a team of ED management, physicians,

General Hospital has embarked on expansion plans

nurses, radiology, and pharmacy that meets on a

over the past few years. The hospital opened a new

monthly basis,” she said. “They are in charge of put-

250,000 square foot pavilion that houses a women’s

ting Lean concepts into place and measuring results.

center and other services. The hospital has also ex-

We also have smaller teams looking at anything from

panded areas to support the increase in

how quickly we can address patients from the minute

obstetrics services.

they enter until we get them to a treatment room, how

The hospital is also in the process of rolling out an

quickly we get radiology or lab reports back. We also

electronic medical record. They chose the Epic suite

have a data subcommittee to measure patient flow so

of products and will begin implementing the system

that we can compare data to see what works and

within the next year.

what doesn’t.”

Investments in quality and efficiency

son said so far she has seen promising results.

Tampa General also takes its commitment to provid-

to grow and meet the needs of its large patient popu-

ing quality care seriously with dedicated efforts to

lation as well as its commitment as a teaching facility.

reduce infections and meet Institute for Healthcare

“We have an organization that we are very proud of,”

Improvement initiatives.

Nelson said. “We make a significant impact on the

“Our quality structure is integrated between medical staff, nursing and other clinical staff,” Nelson

The ED project is still in the early phases, but NelTampa General Hospital continues to look at ways

lives and community we serve. And that’s what healthcare is really all about.”

said. “We have worked collaboratively to decrease or eliminate infections. We have some critical care units that have gone two years with no ventilator-

Tampa General Hospital

associated pneumonia.” Tampa General has received many designations including Magnet certification, Joint Commission Disease Specific certifications, and rankings in U.S. News

Large healthcare organizations are always trying to stay ahead of the curve in terms of quality, technology and patient care services. Tampa General Hospital, in west central Florida, is one of the most comprehensive medical facilities in its region. It serves 12 counties with a population of more than four million. The hospital is also a teaching facility for the University of South Florida College of Medicine.

& World Report. Nelson said the hospital focuses on achieving those recognitions, not for the bragging rights, but because the strict guidelines provided by those organizations are best practices for hospitals to follow. Nelson also credits much of the hospital’s accomplishments, particularly in quality, to the hospital’s collaborative spirit.

Deana Nelson, Chief Operating Officer, said the hospital maintains a “culture of excellence” and believes in achieving its mission statement every day:

“Everyone at every level gets involved in some type of customer service or quality improvement,” she said. “Housekeeping and Infection Prevention have

“Tampa General Hospital is committed to providing the residents of West Central Florida with excellent and compassionate health care ranging from the simplest to the most complex medical services. As a teaching facility, Tampa General partners with academic and community institutions to support both their teaching and research missions. As the region’s leading safety net hospital, we reaffirm our commitment to providing high quality health services to all residents.” The hospital offers a range of services including one of the country’s top ranked transplant centers, a burn center, level 1 trauma center, level 3 neonatal intensive care unit, high-risk obstetrics care, an adult and pediatric brain and spinal cord injury center, and other tertiary services.

been working together on an initiative to make our environments cleaner. The housekeeper will swab an area of the cleaned room and use a handheld device to look for bacteria left behind and can further clean areas that need it. This helps reduce infection.” In addition to quality, the hospital has been working on an initiative to reduce wait times in the emergency department, improving efficiency and customer services. Nelson said the hospital has been using Lean concepts to change the way it manages patients coming into the ED. HCE EXCHANGE MAGAZINE

Real Issues : Real Solutions

Diamond feels being transparent has been a key to

Efficiencies in design and capital spending

success, especially throughout a safety initiative the

Diamond said the health system is always putting cap-

health system has initiated. The organization used

ital dollars into technology, but it maintains a realistic

the Health Performance Improvement approach by

approach to ensure its limited funds are going toward

the Center for Health Transformation. This group

investments that will bring about the most return for

conducted interviews with staff and performed an

patients and the hospital.

Improving safety

organization cultural assessment. Wyoming Medical

â&#x20AC;&#x153;Everybody would like every bell and whistle, but we

of patient harm. They used these factors to create

have to look at whether each bell and whistle will add

three or four patient safety behaviors staff must do.

value to care. Will we get a return on investment? to make sure when we put this in place, we have the

sentinel events online to see whatâ&#x20AC;&#x2122;s really happening

resources so it doesnâ&#x20AC;&#x2122;t just become a piece of equip-

here. We publish a monthly updated that talks about

ment you hang your hat on.â&#x20AC;?

any harm and the cause of it. We have measured safety events each day, and

%8,/',1* 48$/,7< :<20,1* +($/7+&$5( )$&,/,7,(6

What resources and training will be needed? We have

own data to evaluate success,â&#x20AC;? Diamond said. â&#x20AC;&#x153;We log

safety stories, good catches, and whether there was

â&#x20AC;&#x153;We try to do our homework up front,â&#x20AC;? she said.

Center also evaluated its safety, leadership and areas

â&#x20AC;&#x153;We educated staff on the behaviors and use our

18 | Wyoming Medical Center

Technology the hospital has implemented are barcodes for medications, which it has had for nearly

3RSH &RQVWUXFWLRQ LV SURXG WR KDYH SDUWQHUHG ZLWK WKH :\RPLQJ 0HGLFDO &HQWHU RQ QHZ IDFLOLWLHV DGGLWLRQV DQG FRPSOH[ UHPRGHOLQJ SURMHFWV IRU RYHU \HDUV :H FDQ SURYLGH JHQHUDO FRQWUDFWLQJ FRQVWUXFWLRQ PDQDJHPHQW DQG GHVLJQ EXLOG VHUYLFHV IRU KHDOWKFDUH FRQVWUXFWLRQ QHHGV VWDWHZLGH &RQWDFW JUHJ#SRSHFRQVWUXFWLRQ FRP IRU \RXU QH[W SURMHFW

10 years, and a daVinci Surgical System. Diamond said

in the past year, we have reduced our total safety

Wyoming was concerned about buying a daVinci robot

events by 58 percent and tripled the time between

and not using it, but after doing homework and getting

safety events.â&#x20AC;?

stakeholders to buy in, the technology is regularly

The safety initiative is ongoing with further staff edu-

used. The hospital has also begun to implement

cation and development of safety coaches in each unit.

CPOE and has all clinical staff using an electronic health record. Currently, Wyoming Medical Center is renovat-

Wyoming Medical Center

&DVSHU :\RPLQJ

ing part of its emergency room and expanding the

4XDOLW\ +HDOWKFDUH &RQVWUXFWLRQ LQ :\RPLQJ VLQFH

hospital. The first four phases are complete, with one phase remaining. â&#x20AC;&#x153;We took where our cafeteria and production

As a tertiary care facility, serving a large, rural geographical area, Wyoming Medical Center focuses on providing safe, quality care while always being conscious of improving efficiency. The 207-bed hospital sees the majority of trauma cases in the state, providing helicopter service to reach people in remote areas. The hospital is centrally located in Wyoming and has 44 specialties including open-heart surgery. It also has joint ventures with physicians and a multispecialty physician group, Wyoming Health Medical Group.

kitchen are now and are expanding the emergency room into that area,â&#x20AC;? Diamond said. â&#x20AC;&#x153;We are moving those services to a new building that will be attached

ing healthcare environment. The health system has

by patient rooms and a lobby.â&#x20AC;?

been working on controlling costs and evaluating

Wyoming has been working with the design firm HDR on the first four phases. The new emergency de-

ing with physicians in the neurosurgery department

partment will have a pod configuration, which allows

to negotiate prices. Diamond said they saw savings

the hospital to open pods as volumes go up, and

almost overnight by bringing in physicians.

close them when volumes go down in an effort to

Vickie Diamond, CEO

â&#x20AC;&#x153;Our organization is made up of people from all areas of the country, yet we maintain a smalltown philosophy,â&#x20AC;? said Chief Executive Officer Vickie Diamond. â&#x20AC;&#x153;We value quality, knowing we are taking care of our friends and neighbors. Our staff and leadership are involved in community activities and making our community better.â&#x20AC;? For Diamond, part of this small-town philosophy has been remaining transparent with staff. â&#x20AC;&#x153;Whatever the outcomes or consequences, we are transparent with leadership and staff,â&#x20AC;? she said. â&#x20AC;&#x153;We work together to make things better. My goal is to be transparent about the organizationsâ&#x20AC;&#x2122; goals and outcomes.â&#x20AC;?

efficiencies in the system. One effort has been work-

With healthcare reform, the system is trying to de-

improve efficiency. The renovation will also have

termine how an accountable care organization would

separate trauma rooms and beds from a fast track

fit with Wyomingâ&#x20AC;&#x2122;s market. However, safety remains

emergency room.

the health systemâ&#x20AC;&#x2122;s primary focus.

â&#x20AC;&#x153;We want to be efficient in getting people in and out of the emergency department,â&#x20AC;? Diamond said.

Looking toward the future in light of reform As all healthcare organizations in the United States, Wyoming Medical Center is evaluating its processes and trying to determine how it will adapt to the chang-

â&#x20AC;&#x153;We are planning ahead and trying to figure out how to link projects, build organizational reliability and improve safety,â&#x20AC;? Diamond said. â&#x20AC;&#x153;Part of safety is building highly reliable systems and understanding human error so that you can build systems to prevent errors.â&#x20AC;? by Patricia Chaney

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

19 | The University of Kansas Medical Center

The University of Kansas Medical Center The University of Kansas Medical Center (KU Med) serves its state with three medical- school campuses and schools of allied health and nursing. The largest campus, located in Kansas City, has approximately 450 physicians in residency training. The Wichita campus, which focuses on the education of primary-care physicians, has approximately 250. There is a smaller campus in Salina which is expanding its undergraduate medical programs and will soon be offering four-year degree medical programs, as well. Over all, the school has about 3,100 students and around 3,400 employees.

enhance our ability to train new physicians as it really is more reflective of the type of atmosphere they will be practicing in once they finish their training.”

Fulfilling Healthcare Needs in a Rural State As the only academic medical center in the state of Kansas, KU Med is the primary source of the state’s healthcare professionals. Phillips said significant

Ed Phillips, Vice Chancellor for Administration

“We share our main campus in Kansas City with the University of Kansas Hospital which has been a separate entity from the university since 1998,” Ed Phillips, vice chancellor for administration, said. “They are our principal teaching hospital, but they have their own governance and administration.”

portions of the state of Kansas remain underserved because new doctors seem to congregate in urban areas, and Kansas is largely a rural state. This is why several of the school’s initiatives involve expanding programs in Wichita, which is more centrally located,

The largest single source of support for the organization is the state of Kansas which provides about $110 million per year. The remaining two-thirds of their budget is made up from tuition and research programs. They also provide house staff for organizations such as the Veteran’s Administration hospitals in Kansas City, Leavenworth and Wichita and are compensated by the federal government for providing that staff. These programs are generally associated with graduate medical education programs.

“As the new discoveries are coming out of the university, we want to provide a place in Kansas where new companies can incubate in Kansas.”

and Salina. “People who go to school there are interested in primary care and specifically in primary care for the rural areas of the state,” he said. “We think that this program will have a direct impact on identifying interested students and then training them with the specific intent that they would go back into the rural areas of our state to practice.” As well, the university medical program provides valuable access to specialty areas of healthcare that

Enhancing the Patient and the Student Experience In partnership with the University of Kansas Hospital, KU Med is constructing a new 180,000 square foot ambulatory care facility which will bring together most of the outpatient services currently provided in seven different buildings on 13 or 14 different floors. The hospital, while separate from the university, requires that you first must be a staff member at the school of medicine. “The construction of this new building will bring all of the ambulatory care services together in one place, and we’re constructing an adjacent parking garage for patients,” Phillips said. “It will be a significant enhancement to the patient experience for those who

are not available anywhere else in the state. The state’s only pediatric rheumatologist, for instance,

“The construction of this new building will bring all of the ambulatory care services together in one place.”

come to the medical center for care, and it will also

is a faculty member of the school of medicine. That individual conducts outreach clinics into the western part of Kansas where patients would probably have to travel out-of-state to receive those services.

Growing Research Programs Cutting-edge research is also a component of KU Med’s mission. Four years ago, they completed a 200,000 square foot clinical research facility. In addition to the initial investment in construction, approximately $20 million has been devoted to technology since the building was completed. “That investment has allowed us to recruit approximately 40 new faculty members to the university, and we’ve been able to recruit them from the best

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

“the university also becomes a major source of economic benefit to the entire community.” XIOTECH CORPORATION

medical facilities in the country,” Phillips said. They are also in the midst of renovating one of

we want to provide a place in Kansas where new companies can incubate in Kansas,” Phillips said.

their older laboratory buildings through a partnership

“The hope and expectation is that as their products

with the university and the Kansas

reach the marketplace, they will remain in Kansas.

Bioscience Authority.

We see this as part of moving those discoveries to

“The 180,000 square feet that we are renovating is

the bedside and to the marketplace and trying to

going to be devoted to cancer research as part of our

retain those industries in Kansas. Therefore, the

effort for achieving national designation as a compre-

university also becomes a major source of eco-

hensive cancer center,” Phillips said.

nomic benefit to the entire community.”

Another older 40,000 square foot research

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HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

20 | Avera McKennan Laboratory

Streamlining process Serrano said the lab is looking toward expanding

hard to have processes in place to have specimens

molecular testing, particularly infectious disease. Re-

drawn just before the physician visits and have results

cently the lab updated its microbiology infrastructure

available while the physician is still with the patient.”

and stem cell testing. The lab is also bringing histocompatibility testing in-house. “Our hospital is a large Center of Excellence for

To accomplish this, the Lean processes have been extremely important. Serrano said the lab is organized along the lines of functionality rather than discipline,

gastrointestinal disease, and celiac testing is a major

and it spends capital dollars on equipment that is

component. We are doing a lot of work in that area,”

versatile to meet the needs of specialists requesting

he said. “Because we are a tertiary referral center, we

esoteric tests.

have a lot of specialists who request esoteric testing, and we want to be able to do it in-house.” Avera is in a rural area, serving five states. Most patients travel a long distance to receive services at the hospital, some as many as 200 miles. This increases pressure for the lab to perform tests and get results to patients before they leave. “Our goal is for patients to go home and resume therapeutics as dictated by their physician with a minimal amount of trips,” Serrano said. “We have worked

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Avera McKennan Laboratory Hospitals are feeling more and more pressure to streamline and become more efficient. Many are implementing Lean techniques to improve productivity. Laboratory Services at Avera Health, a health system serving five states in the Midwest, has made enormous strides in becoming more efficient. © 2011 Roche Diaagnostics, North America. 467-50499-0211

The lab is located at Avera McKennan Hospital, a tertiary care center with more than 540 beds. The lab is full service and offers all major specialties, including an extensive analysis section with immunology testing. Avera’s Laboratory Services strives to be the best in quality and service and has received multiple recognitions for its efforts.

Leo Serrano, director of Laboratory Services

“We have been strong proponents of Lean since 2004,” said Leo Serrano, director of Laboratory Services. “Because of our Lean efforts, our turnaround times and testing error rates are exceptional. Our average turnaround time from collection of specimen until results are available on the EMR is 35 minutes or less. We are hitting that 95 percent of the time.” In recognition of its efforts, Laboratory Services was the first hospital in the United States to receive ISO 15189 accreditation; it was also the first lab in the country to complete the entire three-year cycle of the accreditation. Avera McKennan has an active transplant enter, and the lab is a full-service blood bank. The lab has received FACT (Foundation for the Accreditation of Cellular Therapy) accreditation and accreditation by the Association of Blood Banks and the American College of Pathology.

Real Issues : Real Solutions

Innovation focused on improving the lives of patients. http://www.roche-diagnostics.us

21 | Catholic Medical Partners

“We envision all our doctors being in a connected system using best-practice medicine and a patient-centered approach to care.”

cian’s office and through common guidelines and patient registries. 2.Assisting with interoperability and optimal use of electronic health records. Eighty percent of physician members have an HER, and CMP is working to improve the exchange of information among those systems. 3.Educating patients. 4.Assisting practices in meeting standards of patient-centered care through its Patient Centered Medical Home leadership program. 5.Becoming a health business model for

Meeting core objectives to improve and integrate care

average age being 30 years old. This has come about

and meet the needs of all its patients. The largest

by working with South Dakota State University.

example of success has been in the emergency room.

“About five years ago, we had difficulty trying to

The main lab also provides services to the ER, and

recruit qualified personnel because of the rural nature

turnaround times are phenomenal.

of South Dakota,” Serrano said. Avera worked with the

“From the time the patient enters the door to the

members examine how to care for populations and produce a margin in the future.

Horrigan said CMP has five strong objectives to assist

The EHR is an essential part of achieving these

its members in providing optimal care to patients and

objectives and supporting members. Horrigan said

position them to move into the future of healthcare,

CMP has made significant investments in informa-

especially in light of healthcare reform. CMP’s objec-

tion systems, data warehouses and analytics. The

tives are as follows:

organization’s current focus is improving “interop-

1.Improving clinical interventions for high-risk

The lab continues working to consolidate processes

accredited care organizations. CMP is helping

erability and the ability for doctors with EHRs to

populations. This is done through an active disease

exchange clinical information. We envision all our

management program that takes place in the clini-

doctors being in a connected system using best-

Catholic Medical Partners

university to develop an accredited Medical Laboratory

ER until they are discharged or admitted is under two

Sciences program. The health system donated $50

hours,” Serrano said. “From the time a patient enters

million to build an allied health building that would

until they see a physician is less than 20 minutes. That

support MLS, nursing and pharmacy.

is a result of cooperative Lean ventures between the

Aligning physicians, hospitals and other care providers, particularly through an electronic medical record, is the future direction of healthcare. Catholic Medical Partners, formerly Catholic Independent Practice Association (CIPA), is leading the way in promoting this coordination and alignment. CMP is a membership organization of about 880 predominantly independent physicians in Western New York, as well as Catholic Health and Mount St. Mary’s Hospital.

“Through this program, we are able to meet the

ER and the lab and the utilization of Lead design in

needs of Avera, the region and students,” he said. “We

both departments. It has been extremely helpful to us

serve as the clinical site for three MLS programs in

as an organization.”

the region. We remain actively involved in education.” The MLS program graduated its first class in 2010

Building the next generation

with 100 percent of graduates passing their board exams and 100 percent placement.

Laboratory Services and Avera McKennan as a whole has made significant investments in building the next

by Patricia Chaney

generation of healthcare providers. Everyone on the management team has at least one or two people in a succession plan, Serrano said. He also noted that Laboratory Services has many young employees, with the

Dennis Horrigan, CEO

“We are a ‘virtual organization’ that provides an overriding organizational structure around improving the delivery of healthcare to populations,” said Chief Executive Officer Dennis Horrigan. “We engage independent doctors and hospitals to make that happen.”

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

these six aims--to make healthcare safe, effective,

using the HER with drug-to-drug interaction lists,

patient-centered, timely, efficient and equitable.

clinical documentation and more.”

In addition to these six aims, CMP follows the

practice medicine and a patient-centered approach

MedVentive Inc.

to care.”

As a founder and CMO of MedVentive, I enjoy

The Patient Centered Medical Home program

supporting the needs of provider organizations

Institute for Healthcare Improvement Triple Aim—the

in the future of healthcare and continues to promote

simultaneous pursuit of three aims: improving the ex-

the Patient Centered Medical Home program as a

perience of care, improving the health of populations,

model for patient involvement in care and optimal

and reducing per capita costs of health care.

utilization of electronic health records.

By focusing on these core values and goals, CMP

emphasizes using systematic, coordinated care

responsible for managing quality and utiliza-

is poised to respond—and help its members respond

that supports access, communication and patient

tion for populations of patients. Prior to Med-

—to the changing healthcare landscape. However,

involvement, while controlling the cost of care.

Ventive, I managed an at-risk network of 4,500

preparation does not come without challenges.

Practices that streamline and follow guidelines

physicians that cared for more than 450,000

related to providing care within this model receive

risk patients. To be successful, we had to

costs,” Horrigan said. “This is going to require a new

recognition through CMP. In addition to the model

create an analytics platform that attributed

business model. Right now, the business model for

for practices, CMP has a leadership series that

patients to providers and disease registries,

hospital is fee for service. The new world is going to

assists practices in establishing the processes and

identified gaps in care and cost reduction op-

be payment for a population. We need to align supply

workflows necessary to achieve recognition.

portunities, and changed physician behavior to

chains of doctors, hospitals, labs, pharmacies to make

reduce costs and improve the quality of care.

the system work better and create the organizational

This experience and technology informs our

culture and execution to make this happen. That is the

best practices today.

biggest challenge.”

Key values that move the organization forward CMP is organized around key healthcare system objectives that fit within the Institute of Medicine’s recommendations in its report “Across the Chasm:

Dr. Jonathan Niloff, Founder and CMO of MedVentive Inc.

Horrigan looks forward to the organization’s role

by Patricia Chaney

“The future of healthcare involves containing

So far, CMP’s model has shown improvements in healthcare within its region. “We have seen reduced readmission rates and

Six Aims for Changing the Health Care System.”

improvement in the treatment of diabetes,” Horrigan

The organization’s corporate programs focus on

said. “We have also seen improvement in doctors

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

22 | Brighton Hospital

Expanding Reach

that may have the effect of increasing the downward

enabling them to track and trend the overall outcomes

The next stage of strategic planning at Brighton

pressure on pricing and the downward pressure on

achieved with the patient population, as well as

Hospital will engage all the stakeholders, from the

controlling costs within the system. That will cause

provide opportunities for cost savings and enhanced

employee base and professional counseling staff

providers to have to look at new, creative ways of

care delivery.

to the providers and referral sources. McCormick

delivering addiction and mental health services in a

expects opioid addiction treatment services, after-

resource-constrained environment. I think the current

The Future of Addiction Care

care recovery support services and medical services

health reform initiative is another example of increas-

“Brighton Hospital has unique value in the market

that are often necessary with the addictive patient to

ing access without increasing the funds available. It

because we’ve been delivering addiction treatment

receive particular focus.

will precipitate a process that will challenge us to find

services for 60 years now. We have seen the trends

“Often times the alcoholic or drug addict also

new creative ways of delivery including different care

and cycles in marketplace and the way society and

has psychiatric problems that require intervention,”

models as well as the use of technology to both sup-

individual patients view addiction. We’ve moved from

he says. “As well, some patients present to us with

port and deliver care.”

addiction being a moral failing to a recognition that addiction is a chronic disease, just like diabetes or

diminished physical health capacity, so being able to

or addiction benefits must offer those benefits under

serve their medical and psychiatric needs as well as

the same terms and conditions as other medical

their addiction is important.”

benefits are being offered. This eliminates the old 30-

Utilizing Information Technology

Ultimately, the mission is to provide the communi-

day coverage rules, for instance. “We don’t say that

“In the world that we are living in today, and increas-

treatment and recovery program that will enable them

ty with quality, cost effective chemical dependency and

for any another disease,” says McCormick. “Cardiac

ingly in the future, technology will be a standard

to manage their care—their chronic condition with ap-

behavioral health services. They work to balance the

or oncology, orthopedics or whatever, we cover the

platform that will be used to not only to support the

propriate support—over a lifetime.

needs of patients with the resources at their disposal

whole spectrum based on medical necessity.”

care delivery side, but to promote a higher level of

and to the extent that they can increase the number of patients and families served.

Greater Access for Health and Addiction Services

“Federal Parity is going to create greater access

engagement in long term recovery,” says McCormick.

for mental health and addiction services. More people

Web-based recovery support programs assist by

are going to have quality mental health , behavioral

keeping patients connected with various recovery sup-

health, and addiction services available to them,”

port services.

he says. The jury is out on a couple of things; with

“We see use of those kinds of platforms being

Federal Parity Legislation, passed in 2008, means

more people accessing those services and no new

increasingly important. If you look at technology rang-

employers and health plans that offer mental health

money coming into the system, you would expect

ing from mobile phones to web-based programs to telemedicine to various type of diagnostic and interventional tools … there’s very fertile ground there for

Brighton Hospital

us to expand and extend the services that we offer,” McCormick says. “Something as simple as a web or phonebased assessment and brief intervention can have material effect on alcohol or drug consumption.

The first addiction hospital licensed in the state of Michigan and the second oldest addiction treatment program in the nation is Brighton Hospital, which was founded in 1948. The hospital campus sits on 92 acres east of Brighton, Michigan. The organization has approximately 100 beds in its various facilities. They offer medical supervised detoxification services, rehabilitation services, and partial hospitalization. They also have a half-way house for men and women and both family and children’s programs to support co-dependencies found within families when treating alcohol and drug addiction. The hospital operates with about 250 employees. “I would say principally our most valuable resource is the committed, dedicated, passionate staff that serves the families who suffer from alcoholism and drug abuse,” says Dan McCormick, Interim President. “A good percentage of our employees are recovering alcoholics and drug addicts, so they bring an empathy and compassion to the treatment process when they deal with patients, family and outsiders. They have a keen understanding of the disease, the disease progression and what it takes to achieve a successful recovery over a lifetime.”

As we look at that as an indicator, we are very excited about the broader use of technology in addiction prevention, treatment and recovery.” Management also looks forward to completing the implementation of the electronic health record,

MCS-iPatientCare MCS-iPatientCare has indeed impressive healthcare IT products, backed by excellent services and support. The completeness of its product portfolio is amazing for ambulatory, acute, sub acute, emergency, and home care.

hypertension are chronic diseases. What we need to do is engage those affected with chronic disease in a

By T.M. Simmons

23 | Delta Regional Medical Center

Design and Technology Highlights of Expansion

should be my primary focus. The more people you

Delta Regional Medical Center just completed a $10

the more efficiently you can run a department,” says

million expansion project that took a little more than

Dillon. “When I assumed this role, the facility direc-

two years. A state-of-the-art heart center was added

tor made all the decisions. It’s much more efficient

to the campus, including brand new operating rooms

to have a network with other colleagues and other

that were built exclusively for heart surgery. An older

facility directors, in addition to networking with all our

area of the hospital was renovated to create a new

staff at our facilities. This enables me to get a general

NICU. As well, the project included an emergency

overview of some different ideas and ways of accom-

room expansion.

plishing things.”

“From an overall perspective, what we are trying

involve and the more opinions and ideas you consider,

“I consider myself a highly trained professional,

to do is move both of our facilities, which are very

but sometimes my way is not always the best way,”

old, into new technology in the best possible way,”

he says. “I’m always very open to ideas on how to cut

says Dillon. “We’re working within the envelope of the

cost, save money, and run the plant. I know when I get

buildings we already have. Sure, we’re going to have

up in the morning, my main objectives and goals are

some restrictions, but we’re taking the information we

to protect my patients, protect my employees and to

have and partnering with some very knowledgeable

protect my facilities to the best of my ability.”

professionals to modernize some of our equipment.” They look toward the LEED program for inspiration

Dillon feels like there isn’t as much competition between hospitals now, but that they tend to focus on

in improving their everyday operations. “Take an area

collaboration instead. These are lessons learned from

such as our lab. We have kind of a moderate flow-

events such as Hurricane Katrina. “We are breaking

through. It’s not a real productive area, so I’m going to

that barrier and saying, ‘Hey, I need to talk to John.

look at the Estopinal Group to help us develop a space

He may have some resources I can use or vice versa.

utilization program to try to put that space over into

I may have ten days worth of food I can loan John

the LEED program. I plan to invite consultants to meet

because he can’t get his food supply in.”

with us to discuss improvement of flow rate, the best whatever will make their job easier and

The Evolution of Hospital Plant Facility Management

more productive.”

When Dillon first began working in healthcare plant

floor space arrangement, and for the employees—

The More People Involved the Better

management, it involved a lot of hands-on maintenance. “When I was hired, there were 12 or 13 technicians at the west campus for a 120,000 square foot

“I have learned over the years through the experience

building,” he says. Now he operates that building with

of being a hands-on Director that communication

four technicians.

Today’s building management is a lot more computer

ing to go down together and when we rise to the top,

driven. “Take water, for example,” Dillon says. “Go-

we’re going to be there together too. I’m not going to

ing out and getting water temperatures used to be a

be the guy who did it alone. My team did it.”

very big task because we had so many different water sources. Now we can control it all at the central plant.

By T.M. Simmons

Now we can look on our computer and see what our systems are doing.” Finding the right employees, therefore, is all the more important. “It’s hard to find a candidate that is dedicated and qualified in healthcare,” he says. “Healthcare maintenance is different than any other type of maintenance because here you are dealing with people’s lives. For instance, if you turn off the wrong breaker, you could impact 10 or 12 patients and it could be detrimental.” He says his biggest challenge is keeping the plant running on a day-to-day basis with as little interruption to services as possible. Any little thing makes them vulnerable. Let’s say the city, for instance, shuts

Delta Regional Medical Center

off the water supply, even if for just a short amount of time. “It impacts many hospital departments. We worry about storms and events we can’t control, but we worry more about things we do have control over

Paul Dillon is the Director of Plant Operations for Delta Regional Medical Center in Greenville, Mississippi. Maintaining a million square feet of hospital and clinical space is no small job. “In addition to two hospitals, I oversee a large network of clinics. My role as Director is to monitor and maintain anything that has an impact on the environment of care, whether it is security, utility, or hazardous conditions such as fire,” Dillon says. He is Chair of the Environment of Care Committee and Vice Chair of the hospital’s Safety Committee.

like water and sanitation,” he says. “I work collaboratively with municipal employees and public works departments. You turn the water off and you’ve got a major interruption. You better have a good plan that is well communicated to face that down time.” “I believe in leading my team from the front. If I ask my guys to go do something, I don’t mind getting right in there with them. I run a family-oriented team. All my guys are my brothers. If we go down, we’re go-

Paul Dillon, Director of Plant Operations

HCE EXCHANGE MAGAZINE

24 | DuPage Medical Group

DuPage Medical Group

Enhancing the Health of Your Community

Serving DuPage county, Illinois, DuPage Medical Group consists of more than 300 physicians practicing in 40 different locations. The group’s history dates back to the 1960s, when the Glen Ellyn Clinic was formed by five physicians. DuPage, in its current state, was formed in 2000. More than half of DuPage physicians are primary care and the remainder make up a variety of specialty areas of medicine. They primarily serve three hospitals; Central DuPage Hospital in Winfield, Edward Hospital in Naperville, and Good Samaritan Hospital in Downers Grove. They serve other hospitals in the surrounding area, as well.

“We have like-minded folks who are on the same team, pulling in the same direction.”

LabCorp strives to be a valued alued partner in th the he physician/patient relationship. hip. LabCorp provides provid des physicians with access to a broad d portfolio portfoli of tes tests, ranging from diabetes and cholesterol screening tests to highly specialized genomic and esoteric assays. Through this relationship, our clients can benefit from the latest in technology and their patients can receive timely, quality results.

“People ask, ‘What is DuPage Medical Group about?

the responsibilities more directly related to their

You seem to be doing well and everybody is happy.’”

job. Training is emphasized for staff as well as

The group works to give its physicians as much

managers. “We try to grow our managers, as well,

autonomy as possible, while taking care of some

and get them the skills. How do you interview?

of the agenda items that physicians aren’t trained

How do you deal with difficult patients or difficult

to deal with, such as hiring, building, and contract-

employees? We are always raising the bar for

ing. “It has given people the ability to really focus

those folks.”

on what they’ve been trained to do, which is to take

LabCorp is proud to be a preferred provider of laboratory services to DuPage Medical Group since 2000.

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physicians to work. It may not be for everybody,

A Patient-Centered Medical Home

Recent years have been years of steady growth for

and that’s okay. We don’t have to be everything to

As of 2010, the group was working toward qualify-

the poverty level. It’s really about trying to take care

Dupage Medical Group. “We’ve grown through three

everybody. We have like-minded folks who are on

ing as a Patient-Centered Medical Home per NCQA

of those folks,” says Baier.

main mechanisms,” says Rik Baier, Chief Operat-

the same team, pulling in the same direction.”

guidelines. “That fits nicely into the strength of a

Together with the hospitals in DuPage county, they

multi-specialty group like us,” says Baier. “We’re

formed a group called Access DuPage, which is an

doing the vast majority of what it takes to be con-

organization intended to provide care to the work-

Physician Owned and Governed

ing Officer. “The first is that good physicians have

care of patients. I think it’s been a great place for

lots of patients and they need to bring in partners to

C.A.R.E. Starts with Hiring

help them. So we’ve grown through just actual need

“Our folks in our HR department are excellent and

sidered a medical home right now. We’ve been very

ing uninsured. “We provide the bulk of primary and

and demand in patient care.”

do a fabulous job of evaluating folks,” says Baier.

proactive with that.”

specialty care for those folks. Those numbers have

Primary care has been the demand area of

“It’s easy to train people on tasks; it’s hard to train personality.”

According to new standards released in

been growing a little bit with the economic times.

January 2011, the NCQA website states that, “The

It’s about balancing that with our ability to stay solid

of growth for the group has been in the addition of

They focus on people who already seem to in-

patient-centered medical home is a model of care

and continue to grow and fuel the growth we have

specialty groups. Recent additions have included

nately understand the groups core values: Compas-

emphasizing care coordination and communication

here so that we can continue to give back,” he says.

oncology, ophthalmology and neurology.

sion, Accountability, Respect and Excellence. “The

to transform primary care into “what patients want

“It’s a tough balance but it’s something we need to

goal is take care of the patient and do what’s right

it to be.” Research shows that medical homes can

do to give back to the community in some fashion.”

in the community who have approached us about

for the patient. Growth will come from that. The

lead to higher quality and lower costs, and improve

becoming part of DuPage Medical Group. Being

ability to continue to expand or just offer the right

patients’ and providers’ reported experiences

like-minded, with similar cultures, it has worked

services comes from doing the right thing for the

of care.”

out well,” Baier says. A lot of this type of addition

patients. Those values absolutely encapsulate what

has been in primary care, internal medicine and

we do.”

growth in the county, but the second mechanism

Third, “We’ve had physician groups established

sations going on between physicians,” says Baier.

By T.M. Simmons

the patient. In these economic times, people are

All newcomers to the organization undergo

struggling. We’re blessed to be where we are, in a

multi-day training events. They learn about the

fairly economically affluent area. There are still an

overall scope of the organization before focusing on

awful lot of folks out there who are uninsured or at

family medicine. “Recruitment is really in a lot of hallway conver-

“I think it comes back to doing what’s right for

*Since the time of our interview, Mr. Rik Baier has left DuPage Medical*

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

25 | Gilbert Hospital

He takes a unique approach to building hospitals

proach makes them feel valued and as though they

as well. Rather than looking for large communi-

are receiving extra care.

ties that can support a 400-bed hospital, Dr. Johns

Plus, nurses feel valued. The turnover rate at

looks to open hospitals in smaller communities

Gilbert is under 3 percent, as opposed to 24 percent

with a need for emergency care close to home.

for the state of Arizona.

A new facility in Florence, Arizona, is under con-

port they need and time to pay attention to quality

This hospital is in an area with 13 prisons, housing

measures. Dr. Johns said the hospitalâ&#x20AC;&#x2122;s quality

about 19,000 prisoners. The new facility will have a

standards according to the CMS indicators are

lock-down wing to provide separate care for prison-

exceptional.

ers away from the main hospital population. Funding always remains a challenge, but Dr. Johns is confident that if the management team puts patient care first, the money will follow. â&#x20AC;&#x153;Funding hospitals like this is difficult,â&#x20AC;? he said.

â&#x20AC;&#x153;At previous hospitals, we had highly educated doctors and nurses who knew what needed to be done at the bedside, but they werenâ&#x20AC;&#x2122;t given the proper voice,â&#x20AC;? he said. So he started Gilbert Hospital, a 25-bed acute care general hospital in the small town of Gilbert, Arizona.

â&#x20AC;&#x153;Doctors used to run hospitals,â&#x20AC;? he said. â&#x20AC;&#x153;The control of medicine needs to be back in the hands of providers. Nobody knows whatâ&#x20AC;&#x2122;s better for patients

emergency rooms lose money. But we will continue

than those providing the care at the bedside.â&#x20AC;?

At Gilbert Hospital, the medical staff are emmanagement staff is required to support the medical staff in their needs. For example, if a physician needs a new piece of equipment to provide care, rather than requiring him to present a return on investment to multiple committees, Gilbert Hospital leadership will do everything within its power to In addition, when many emergency rooms have one nurse assigned to four patients, Gilbert takes a â&#x20AC;&#x153;Patients are seen by a team consisting of a registered nurse, a paramedic, and a technician,â&#x20AC;?

teract efficiently with even one other department, the

Dr. Johns said. â&#x20AC;&#x153;Each team takes care of six beds.

whole system began to break down,â&#x20AC;? he said.

This approach has the same dollar per hour cost as

Dr. Johns finally decided to embark on his own

way up the ladder to the Board of Trustees level.

(;3(&7 025( )520 <285 +,0 62/87,216 3529,'(5

powered to make change and suggest ideas. The

team approach at the bedside.

one nurse seeing four patients, but the nurse has

But he became more and more frustrated with the

to establish a small, community hospital focused on

time to do what sheâ&#x20AC;&#x2122;s trained to do -- give medica-

administrative procedures and the way depart-

providing emergency care. Although he was told it

tions, assess reactions to those medications, do

ments operated as silos, even though, as he said,

wasnâ&#x20AC;&#x2122;t possible, Dr. Johns opened Gilbert with only

procedures.â&#x20AC;?

the emergency room was intertwined with 13 other

two inpatient beds, and in the past five years has ex-

departments.

panded to 25. The hospital continues to grow with the

dous success through this unique approach. He

community and is about to break ground on space for

said patient satisfaction scores are â&#x20AC;&#x153;through the

an additional 40 beds and increased ICU capacity.

roof.â&#x20AC;? From a patient perspective, the team ap-

as possible, but if the emergency room couldnâ&#x20AC;&#x2122;t in-

volved in the business of providing healthcare.

â&#x20AC;&#x153;Our main service line is emergency services, and

ensure the physician gets the equipment he needs. â&#x20AC;&#x153;We donâ&#x20AC;&#x2122;t want an MBA approach to healthcare; we want a healthcare approach to healthcare,â&#x20AC;? he said. â&#x20AC;&#x153;At Gilbert Hospital, the management team gets their direction from those providing care.â&#x20AC;?

â&#x20AC;&#x153;We tried to make each department as efficient

would encourage physicians to become more in-

Taking a medical staff-led approach to providing care

In many health systems, administrators and boards -- made up of business degrees and former clinical professionals -- make the business and bedside decisions for staff and patients. But Tim Johns, MD, an emergency medicine physician, decided that system wasnâ&#x20AC;&#x2122;t working and set out on his own to begin a hospital run by the medical staff.

Dr. Johns worked for a larger hospital, working his

Through this experience, Dr. Johns said he

to do the right thing, and the money will catch up.â&#x20AC;?

Gilbert Hospital

Challenging the status quo

The team approach also allows nurses the sup-

struction and about halfway through completion.

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Dr. Johns said the hospital has seen tremen O ZZZ GLVNULWHU FRP O VROXWLRQV#GLVNULWHU FRP

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

26 | Providence Health and Services

3529,'(1&( 5(*,21$/ 0(',&$/ &(17(5 (9(5(77 :H FRPPHQG \RXU FRPPLWPHQW DQG GHGLFDWLRQ WR SURYLGLQJ ZRUOG FODVV DZDUG ZLQQLQJ KHDOWKFDUH WR 1RUWKZHVW :DVKLQJWRQ 7KDQN \RX IRU PDNLQJ XV D SDUW RI \RXU YLVLRQ

Examples of Flexibility In the beginning, the tower was designed with the idea that every inpatient room would be adaptable to both private and semi-private conditions. â&#x20AC;&#x153;Everybody would like to have all private rooms, but as your census changes radically, there are points of time in your growth where that is not realistic,â&#x20AC;? Anderson said. Also, the initial goal was that every room could be converted into an ICU when needed (acuity adaptable). Reality, of course, is that flexibility of this type is expensive. Because of the 2008 economic downturn, they had to go back and figure out where they could take $50 million out of the half-a-billion dollar project after the project was under construction. â&#x20AC;&#x153;We got to a point where we looked at these rooms and decided we couldnâ&#x20AC;&#x2122;t afford to build all of

ZZZ ]JI FRP

them to the prime level of flexibility, so we picked a percentage that we were comfortable with,â&#x20AC;? Ander-

Providence Health and Services

son said. Now one of every two wings has acuity-adapt-

In June of 2011, the Cymbaluk Medical Tower at Providence Regional Medical Center in Everett, Washington, will open. It is the largest capital project that Providence Health and Servicesâ&#x20AC;&#x201D;a 150-year old, five-state organizationâ&#x20AC;&#x201D;has ever undertaken. The enormity of this project, which will result in an additional 16.3 acres of floor space for the hospital, is impressive even for a hospital system of this size. â&#x20AC;&#x153;Although it is a hospital addition, itâ&#x20AC;&#x2122;s essentially a replacement of all the acute-care aspects of the current hospital. It is a 12-story project with 700,000 square feet, five floors of inpatient care, 368 new beds for inpatient care, two floors dedicated to invasive procedures with 28 rooms that are either OR, cath labs, or interventional radiology. The rooms are designed on a 700 sf module for technological flexibility,â&#x20AC;? Scott Anderson, vice president of construction project management, said.

able to anticipate and respond to that in the design process. One way we do that is to try to develop design modules for basic clinical functions that maximize flexibility and work toward the universal room concept.â&#x20AC;? Because technology changes often affect the volume of a particular healthcare procedure, such as the need for cath labs, flexibility in design is crucial. An example of this is the two floors for invasive procedures. They are designed for a combination of conventional surgery and all kinds of imagingenhanced surgery. â&#x20AC;&#x153;We picked a module that we could fit any of

Start with the Right Team and Flexible Design Standards â&#x20AC;&#x153;The real trick to a successful project of this size

team assembled before the architect began schematic design. It was a constant process of constructability review and value engineering. From the end of master planning to occupancy,

is to put a comprehensive design and construc-

the project will have taken about six years. A lot can

tion team together before you get into schematic

change in that time, especially in regards

design,â&#x20AC;? Anderson said.

to technology.

He had his general contractor, mechanical and electrical subcontractors, and the whole design

â&#x20AC;&#x153;Both technology and clinical practice are continually evolving,â&#x20AC;? Anderson said. â&#x20AC;&#x153;You have to be

the technologies into. Our volumes change over a six-year period, as well. It allows us to have rooms that could have been cath labs, but are now going to be something else,â&#x20AC;? Anderson said. â&#x20AC;&#x153;Trying to keep everything that accommodates the hard aspects of the hospital as flexible as you can is really all you can do. I know five years down the road some of those roomsâ&#x20AC;&#x201D;very expensive roomsâ&#x20AC;&#x201D;weâ&#x20AC;&#x2122;re going to be doing something totally different to them.â&#x20AC;?

able rooms and 14 percent of the rooms can swing from private to semi-private. â&#x20AC;&#x153;First you have to identify what your ideal is, then you have to compromise to keep within your budget,â&#x20AC;? Anderson said.

The Path to End Design and Utilization An added element to the design process was the input and involvement of people who were to be the end users. This included design input from a patient and family advisory council, as well as medical directors who were given a stipend to attend numerous design meetings and represent the physician and patientâ&#x20AC;&#x2122;s needs for the design process. â&#x20AC;&#x153;Itâ&#x20AC;&#x2122;s created a much better design and also helped with integration of the clinical needs with the patient and family experience,â&#x20AC;? Anderson said. â&#x20AC;&#x153;Some areas of healthcare take a lot of effort to get the end result right.â&#x20AC;? By T.M. Simmons

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

27 | Schneider Regional Medical Center

Schneider Regional Medical Center

Angela Rennalls-Atkinson, COO

There is one government run healthcare system for the Island of St. Thomas. It is Schneider Regional Medical Center, which includes The Roy Lester Schneider Hospital, The Myrah Keating Smith Community Health Center, and The Charlotte Kimelman Cancer Institute. The hospital was opened in 1982 and is an acute care, 169-bed facility. The cancer center, open since 2006, provides radiation, oncology treatment and medical oncology. The community health center sees urgent care patients on the island of St. John, the location of the Virgin Islands National Park as well as ambulatory services to the 5,000 residents. Overall, the system serves the islands of St. Thomas, St. John and the approximately 2 million visitors who arrive each year by air and cruise ship.

Schneider is working to build the infrastructure necessary to accommodate physician order entry and complete computerized monitoring of programs. “We

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says Rennalls-Atkinson, “but we’re not doing ordering. Certainly our infrastructure and the finances to cover those immediate services is a challenge right now. We do get money from the government for personnel, but we do not get capital funds. So that’s a big project right now, trying to get funds so that we will be able to meet the standards that will apply in 2012.”

Meeting the Needs of the Community “Our goal is to insure that we can meet the needs of The Virgin Islands are a part of the United States;

the community,” says Rennalls-Atkinson. “That means

so all laws applicable to the mainland are also ap-

we have not only internists, but a number of special-

plicable for Schneider Regional. One of the things

ists so that we decrease the need for a person to go

on top of the agenda, according to Angela Rennalls-

off-island for treatment. We employ those physicians

Atkinson, Chief Operating Officer, include insuring

when they come.”

that Schneider meets all the standards of Medicaid and Medicare services and other federal agen-

Recruiting and maintaining medical personnel has

cies. The hospital is joint commission accredited.

been met with some success. Covering nursing and

Some of the areas of specialty include cardiology,

some of the ancillary areas has been an ongoing

hematology, oncology, maternal health services,

challenge. A large portion of Schneider staff is agency

endocrinology, and pulmonology. “Really, it’s very

staff, brought in from the mainland. Schneider works

comprehensive care, including emergency,” says

with the University of the Virgin Islands to provide

Rennalls-Atkinson.

internships and engage students within the system. “They have the practical experience on the nursing

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unit so that they can become more familiarized with the clinical environment,” says Rennalls-Atkinson.

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tomed to the hospital environment and community. Since there is only one hospital, we hope that they will come back and decide to work with us.”

The Ever-Present Search for Capital Dollars The reality of funding at Schneider means that capital expenses are often paid for out of operating funds. There are always cuts in the dollars that can be spent, and one answer has been to focus more on marketing services to make sure people are aware that the hospital exists. “We get a lot of cruise ships passengers and visitors. When someone goes on vacation they do not expect to get sick, but if they do get sick, they want to come to a facility that can provide for their needs. It does require us to spend a lot of our operations money so that we can upgrade our equipment constantly so that we can stay competitive with the rest of the market,” says Rennalls-Atkinson. By T.M. Simmons

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

28 | St. Joseph’s Health System

denials and increase collections, and a productivity system to improve accountability. Randolph said the system is looking for ways to become even more efficient in preparation for healthcare reform, particularly in the case of Medicare reimbursement. “We are looking to create our future rather than respond to reform,” he said. “We are focused on trying to partner with physicians to help them through this challenging time of reduced reimbursements.” Despite financial struggles common to most hospitals, St. Joseph’s hospitals are number one in market share in each region. This has allowed the health system to increase capacity in almost all facilities. “We needed to retrofit our California facilities to comply with new state legislation, and we took advantage of the opportunity to develop master facility plans for each California hospital,” Randolph said. “We have three new bed towers in Orange County and another near completion.”

St. Joseph’s Health System

Randolph said the system also has plans for a new hospital in Apple Valley, which will include outpatient services and medical office buildings.

St. Joseph’s Health System is a large system of 14 acute care hospitals, plus home health agencies, hospice care, outpatient services, community clinics and the second largest Medical Practice Foundation in California. The system covers three diverse geographic regions: Northern California, Southern California, and West Texas/ Eastern New Mexico. This diversity has helped the hospital weather the economic storms happening in healthcare throughout the country, said Executive Vice President and CEO Joe Randolph.

Joe Randolph, EVP and COO

Empowering employees to innovate In addition to efficiency, innovation is a big focus of St. Joseph’s moving into the future. The system is structured traditionally, but the system tries to keep as few management layers as possible. This has allowed St. Joseph to be nimble and able to

CEOs of each location. Part of this communication

make timely decisions.

has been to seek innovative ways to improve health-

“Our individual hospitals are able to make deci-

care and operations for the future. St. Joseph’s re-

sions and respond quickly to changes in their mar-

cently held an Innovation Summit where it brought

kets, rather than having many layers of manage-

in speakers from a diverse group of industries – a

ment within the system,” Randolph said. “We also

rocket scientist, a Microsoft employee, a bioscience

“When one market is down another is up,” he said.

“After the market crash in 2008, we needed to

have a tiered governance where many decisions are

engineer, a venture capitalist, and others. They

“This geographic diversity gives us strength in

make improvements in operations to rebuild our

made at the local level, and capital allocations and

formed a panel to inspire innovation throughout the

terms how different markets respond to regulatory

portfolio and strengthen our financial position,”

budgeting decisions are made at the system level.

organization.

changes, legislation, labor costs, reimbursement,

Randolph said. “We implemented Lean processes

We have a tremendous sense of team within the

and contracting.”

at each facility and have seen significant improve-

health system. When one location needs help, they

that incremental changes won’t get us where we

Becoming part of a large, integrated health

ment in our value stream. With the Lean process,

can find it at one of the other locations or from the

need to be,” Randolph said. “We need breakthrough

system seems to be the future for many healthcare

we empowered managers at all levels to improve

system. The culture is grounded in our heritage as

change, and that is what the Summit was all about.”

facilities. But even in a system like St. Joseph’s with

operations and reduce waste.”

a faith based system”

“In the future we will be looking to Innovation to

Some Lean initiatives involved supply chain

more than $4.2 billion in revenue, efficiency and innovation are keys to economic survival.

management, a revenue cycle initiative to reduce

Communication among all the ministries has been key, and Randolph regularly interacts with the

“Anticipating the future of healthcare, we realize

take us to the next level of performance, to improve the health of the communities we serve.”

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

29 | UMass Memorial Medical Center

their own medical center. They are number one for

to the supervisor with a report that they’ve been doing

heart-attack survival in the state of Massachusetts

since 1991.

and number five in the country.

Leading Healthcare Reform The state of Massachusetts has been at the fore-

reported. “We don’t think anybody actually looks at it anymore.” “I think one of the key things is to get close and

front of the health-reform movement, even before

just admire and respect the people who really do the

it was nationwide. As a state, they have achieved

work, the folks who are taking care of the patients and

almost 97 percent coverage of their population.

those who support them,” Ettinger said. “I’ve always

“The recession hit and that really drove home

said we’re a team organized around the patient and

the point that we need to get costs under control,”

everybody should know what their path to the pa-

Ettinger said. “The financial healthcare crisis

tient is. For the doctors and nurses, that’s easy, but

isn’t a function of coverage; it’s a function of the

if you’re an IT person or a finance person or a house

recession, and in the face of that recession we are

cleaner, what do you do that really enhances that

looking at ever-increasing costs. I would say people

patient experience? I think it’s important for people

across the aisle, although this is a blue state, sup-

to recognize that they are performing extraordinary

port what we are doing and are still enthusiastic

tasks in your organization every day. You’ve got to

about what Massachusetts has done.”

keep remembering that. It is the key to everything.”

As the state began making changes that are

UMass Memorial Medical Center

“It takes each of us half a day to complete it,” they

now being asked of hospitals across the nation,

By T.M. Simmons

they have remained in the top five in almost every category of healthcare in terms of access and qual-

The hub of healthcare for central New England is UMass Memorial Medical Center, a three-campus organization with 781 beds located in Worcester, Massachusetts. They partner with four other community hospitals under the name of UMass Memorial Health Care. They are also the primary teaching hospital for University of Massachusetts Medical School.

ity of care. The business model of healthcare is changing, however, and Ettinger said that pay-for-service will soon be a thing of the past. “I believe it is a permanent change, and I believe it is transformational change,” he said. “The focus is largely economics. The country just can’t afford

“We have about 550 residents and fellows and about 450 medical students,” Dr. Walter Ettinger, president of UMass, said. “We are also a teaching site for a number of other programs. We have about 1,000 nursing students come here every year for their clinical rotations from schools all around the region.”

Dr. Walter Ettinger, President

The hospital is a level one trauma center for both pediatric and adult patients. They have a level three neonatal intensive-care unit. As well as being the tertiary care center for the area, they are a community hospital providing about 60 percent of the care within the region.

A Focus on Integrated Care

Even though UMass Memorial is an academic medi-

Care at UMass begins when an ambulance first

cal center, their highest priorities are better care

picks up a patient.

for patients and the improved health of the com-

“We coordinate that care for heart-attack vic-

munity. “We put the needs of our patients first,” Ettinger

tims and stroke victims and others right through to the time they are discharged to rehabilitation ser-

said. “We view our success as a combined enter-

vices,” Ettinger said. “That’s one of the things we

prise and not as the work of individual entities.”

are most proud of--our integrated care models, our

The UMass heart and vascular program

clinical integration and the quality it has achieved.”

includes other hospitals in the region as well as

this anymore.”

Empowering the Employees “I am really excited about using the lean process to take the waste out,” Ettinger said. “The reason I get so excited about that is it involves the people really doing the work. One of the things that I think is absolutely necessary is to have a really committed

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St. Jude Medical

and engaged medical staff and professional staff.

is a Proud Sponsor of the UMass Memorial Medical Center

One of the ways to do that is to give our doctors, our

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nurses, our pharmacists the power to go home and say to their spouses, ‘I have the power to improve the care, and I have the power to make this a better place to work. I can affect change.’ Lean is a great way to do that.” As an example, UMass recently had a luncheon celebrating a reduction in waste for their trauma team. Two members who work in the trauma reg-

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istry had been reviewing their processes and went HCE EXCHANGE MAGAZINE

Real Issues : Real Solutions

MAR/APR

2011

Real Issues : Real Solutions

HCE Exchange Magazine EDITORIAL Editor-in-Chief Tiffany Ford Editor: In-Focus John Abraham Contributing Writers Teresa Pecoraro Jacqueline Rupp David Winterstein Meghan White Tracy Simmons Kathy Knaub-Hardy Editorial Associates Levent Nebi Deepa Bhatia Lori Ryan Anami Mittal ART DEPARTMENT

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