“The number one service the community was looking to have was emergency department service, so they didn’t need to drive over half an hour or go across the bridge to get emergency treatment,” recalls Carole Peet, who would become president of the new facility, St. Anthony Hospital.
That need, combined with patient overflow at St. Joseph Medical Center, Franciscan’s tertiary hospital in Tacoma, convinced the system to seek certificate-of-need approval for a new community hospital in Gig Harbor. The system submitted the CON application in Aug. 2003 and it was approved in May 2004. Construction of the 80-bed hospital began in April 2007, and the hospital opened in March 2009. The total cost was $160 million.
A fresh start
Many of the challenges community hospitals face involve aging facilities, outdated technology, increasing competition and rising costs. While St. Anthony is not immune to some of today’s challenges, the hospital is fortunate that it could address some of them in the planning and development phase.
“If you’re purchasing an older building, you’re always trying to retrofit technology and different types of machines,” Ms. Peet says. “With a new building, you can plan for where computers are going to go so staff and physicians have access to that, and you can plan for future growth.”
While St. Anthony is licensed for 80 beds, it was built with a fifth floor shell that has room for an additional 32 beds if the system decides to go back to the state for CON approval for expansion. A sky bridge connects it to an adjacent 85,000-square-foot medical office building with physician offices, a cancer care center and other services. The hospital has all private rooms, an environmentally sensitive design and construction, a healing garden and state-of-the-art technology. Natural landscaping has been preserved on more than half of its 37-acre site, with wetlands and a stream populated by salmon.
Reflecting the community’s needs
Bells and whistles aside, the hospital’s main purpose is serving the needs of its community, and Ms. Peet says that means providing top-notch emergency care and other basic services. “We don’t do open hearts, we don’t do heads; that’s really the role of a tertiary facility,” she says. Much of the hospital’s business is outpatient surgery and outpatient diagnostic care, but it also offers Level 4 trauma care and a cardiac catheterization lab.
Unlike many community hospitals, St. Anthony does not provide maternity services, says Budd Wagner, vice president of marketing and communications for Franciscan Health System. “Although we did deliver one baby in the ED,” he notes. With only about 500 births annually in the community, it was not clear that the population could support a first-rate maternity program, although the service line will be reconsidered when the hospital decides to pursue expansion into its fifth floor if demographics have shifted, he says.
Commitment to best practices in the ED
Given its community’s need for efficient emergency care, St. Anthony has committed to fostering best practices and superior service in this area. “We wanted to do something to see if we could manage our emergency department differently and really meet our customers’ expectations, Ms. Peet says.
Rather than conducting traditional triage, the hospital uses a “split-flow” model. Instead of registering, then seeing a nurse, then waiting to see the physician, a patient in this model is registered quickly and seen by both a nurse and physician at the same time. All of the patient’s clinical information is collected at once (instead of twice), so the physician can start the care plan, order any lab work, imaging or other services and move on to the next patient while the lab work is being done. “It moves the patient through the process that much faster,” Ms. Peet says.
The results so far have been impressive from both a throughput and patient satisfaction standpoint, she says. While the traditional goal of “door-to-doc” time in an ED is 30 minutes or less, with many hospital EDs having wait times of several hours, St. Anthony’s door-to-doc time has been 10 minutes or less since it opened. “It’s a huge satisfier for our patients,” Ms. Peet says.
Another relevant emergency care statistic is the number of patients who come into the ED and leave without being seen. For most hospitals, that number can range from 4 percent to 6 percent. Since St. Anthony opened, only two patients have left its ED without being seen, Ms. Peet says, which translates to some 0.001 percent of its ED patients. Additionally, the hospital has scored every month in the 99th percentile for patient satisfaction in its ED, according to Healthstream, she says.
Building a physician base
One challenging aspect of starting a hospital from the ground up is building relationships with physicians, Ms. Peet says. There was no existing medical community in Gig Harbor. “Because we were a green field hospital, we had no established medical staff,” she explains. “One of our challenges was really talking to all of our physicians and seeing how we would staff certain services.” Currently, more than 90 percent of St. Anthony’s physician services are provided by members of Franciscan Medical Group. The multispecialty group, owned by the Franciscan hospital system, is based in Tacoma and employs 186 physicians, as well as physician assistants, nurse practitioners and nurse managers.
Financially, St. Anthony has exceeded the expectations outlined during its CON application process, says Ms. Peet. In its original CON application, Franciscan estimated the hospital would break even within its first two years.
“During the last two months, we’ve had positive cash flow and a positive operating margin,” Ms. Peet says. “We’ve met the thresholds of volume and activity that allow us to meet expenses. I think we’ll see cash flow and margins continue to grow.”
Learn more about St. Anthony Hospital.
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