From Building a Golf Course to Building a Hospital: BayCare Clinic CMO Dr. Paul Summerside

Paul R. Summerside, MD, MMM, CMO and chief compliance officer of BayCare Clinic in Green Bay, Wis., is not one to give up easily. Not when he has to arrive at a golf course before 5 a.m. to get tee time or when he's called the "devil incarnate" for his beliefs about hospital quality. As an emergency physician at Aurora BayCare Medical Center and a leader of one of the top health systems in the nation, Dr. Summerside is accustomed to facing challenges head on and persevering until he reaches his goal.
Dr. Paul Summerside shares his experiences as a leader in healthcare.The drive for golf
There was a shortage of golf courses in Green Bay in the late 1980s. As an avid golfer, Dr. Summerside did everything he could to continue playing, even lining up outside at a public golf course before 5 a.m. to be assigned a tee time before the schedule filled. "After doing that a couple times, I said there's just no way I can play golf like this," he says. The only private country club in the town, however, had a 20-year membership waiting list. Instead of giving up the game he loved, he decided to build his own country club and golf course with the help of many other like-minded people. He served as construction manager by day and ED physician by night to fulfill his goal. Now, the golf course is one of the top courses in the state, he says.

Dr. Summerside brings this ambitious and committed attitude to healthcare as well. "I've always been a positive guy," Dr. Summerside says. "I get up every morning, look in the mirror and ask myself the question 'What is it you can do today that will make things a little bit better for your patients today than yesterday?' If you get up every morning and ask yourself that, it drives the practice of medicine in a good direction." It wasn't until the 1990s, however, that Dr. Summerside began to channel this positive energy into changing a system of healthcare delivery that he and some colleagues believed treated physicians and patients like commodities.

The reign of commodity-based medicine

In the early- to mid-1990s, medicine was thought of as a commodity-based purchase, according to Dr. Summerside, who served as a managing partner of an emergency physician group at a hospital prior to BayCare. People with this medicine-as-commodity perspective considered physicians and patients as largely homogenous groups that could be bought or sold solely to optimize revenue. "We took a different path," Dr. Summerside says of his physician team. "We [believed] there was in no way any kind of homogeneity within the physician population or hospital population, that one physician had enormous differences compared to another, both in style and quantifiable quality."

Dr. Summerside and other ED physicians at the hospital believed that changing from a healthcare system based on commodities to one based on quality would improve care and ultimately yield greater savings. "We believed there was a market for people willing to deliver a better product and work a little harder — that value wasn't about necessarily unit cost alone. And in fact there was an enormous amount of value outside of the unit cost of service and consumers would appreciate that," he says. "No one brags that they went to the cheapest heart surgeon in the United States. And yet that was the mentality of a segment of market."

An uphill battle
To change this mentality, Dr. Summerside and other physicians began advocating for a shift to focus on the quality of healthcare rather than price alone. Changing deeply embedded beliefs about the healthcare system was very difficult, however. "I remember having an argument with an administrator that we split with. [The individual] said 'What are you talking about quality for? Quality doesn't matter. It's price, price, price.' And that was how a portion of the industry viewed it. That was the mantra of that culture."

Some leaders in the industry did not only defend that view of healthcare, but also attacked this new view of quality in healthcare. "We were told we were greedy. They kept thinking that our focus on quality and performance was a tactic to get more money from them, and it wasn't. It was a philosophical difference," Dr. Summerside says. Opposition to this new philosophy also moved beyond the healthcare arena and became personal. "I personally was called the devil incarnate," he says. "They attacked us in the press, at country clubs, in women's groups [and] at business luncheons." The opposition was so great that the hospital eventually ended its contract with Dr. Summerside and the ED physicians in 1999.

A new beginning

Rather than viewing the split as a setback, however, Dr. Summerside turned the situation into an opportunity to partner with other frontrunners of the quality-focused philosophy and build a new hospital based on quality care. Although opponents continued to try to prevent Dr. Summerside and the ED physicians from realizing their goal — they offered individual physicians payment to leave the group — Dr. Summerside's team assisted in the creation of a new hospital. In 2001, Aurora BayCare Medical Center opened. The hospital became the first in the country to guarantee service in the ED within 33 minutes, and it began tracking complications, infection rates and other quality-related outcomes years before it became standard practice in hospitals. Now, the hospital is ranked by CMS among the top 10 percent of U.S. hospitals for several specialties and is one of the most profitable hospitals in the region. Meanwhile, the organizations that treated healthcare as a commodity have gone bankrupt, according to Dr. Summerside.

Dr. Summerside emphasizes that the creation of a hospital with a new focus of care was a collaborative effort among many individuals who shared the belief that quality should come before cost. He also credits his wife and family for supporting him in his efforts to beat the odds in helping to build both a new country club and a new hospital. He says that when the ED group and he got fired from the hospital, his wife encouraged him to develop a new hospital and not to go back to the hospital despite having four children and needing steady income. "When you have that kind of support, it makes it a lot easier to pursue what you feel is right," he says.

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