Putting Communities in Charge of Hospitals' Future

It's getting clear that government can no longer support healthcare in the manner to which it is accustomed. As federal and state governments stagger under huge deficits, payments from entitlement programs such as Medicaid and Medicare are being cut back.

To thrive in the future, hospitals will have to reinvent themselves. A key resource to do so will be their local communities. Granted, non-profit institutions, including Catholic facilities like my own two hospitals, are already deeply committed to their communities. But hospitals can do much more with their communities.

My two hospitals in western Wisconsin started going down this road last year. We had been discussing our next five-year strategic plan and I was getting tired of plans with no soul, focusing on a lot of quantitative data. We already had been hitting all of our financial targets, and I felt it was time to look beyond that. It was time to go beyond charts and graphs.

We came up with a plan called "Imagining the Future: 2016." Our goal was to move in a new direction. We wanted to discover what really matters for our community. We wanted to reach out to everyone in it and have a conversation on what healthcare means to them and their families, with the goal of improving the healing experiences of every patient we see.

We found an outstanding resource to guide us through this process. Pamela Wible, MD, a family physician, pioneered the community approach when she was planning a new practice in Eugene, Ore. In a series of meetings she asked the local community to tell her what her new practice should be like and they came up with all kinds of useful, innovative ideas. We wanted her to help us do the same thing on a larger scale with our hospitals.

Asking people to dream
Dr. Wible asks people to "dream" – to talk about their deepest aspirations for their own healthcare without worrying about costs, planning or anything else. We just wanted them to tell us what they wanted to see and our role would be what I call "deep listening." We took every idea seriously, even when people suggested very unusual approaches, such as bartering for healthcare services.

We started from the premise that each hospital's community is different, with its own needs. For example, we have an Amish community nearby. The Amish, who spurn cars in favor of horse-drawn buggies, do not believe in buying health insurance. That poses an interesting challenge for payments and it is what pushed the conversation toward bartering. The Amish grow crops that we might use in our cafeteria.

Dr. Wible came for two days last October and met with a variety of groups. We had more meetings after she left, seeing a total of 1,600 people. We met with priests and parishioners, seniors in an assisted living facility and school kids in kindergarten, fourth and eighth grades. We reached out to people who are often ignored, such as chemical dependency patients, the Amish and Hmong people, refugees from Southeast Asia who settled in the area in the 1970s.

What we found out
People really opened up to this approach. To date, we have collected 100 pages of testimony involving 2,830 pieces of data. A committee representing the hospital and the community has identified 700 recurring themes that we wanted to focus on. More than anything, people wanted to be heard, understood and cared for. Rather than just run a bunch of tests, they wanted us to look at patients' needs.

We learned how the attitudes of different groups affected their healthcare and we discussed what we could do about it. For example, Hmong people have a taboo against children discussing their parents' deaths, so we followed up by translating our advanced directives into Hmong. And the Amish, lacking health coverage, board trains and travel to Ohio and Mexico to find lower-cost elective surgeries. It bothered me that they had to leave the community for this. We considered possible expansion of our free clinic in addition to bartering as a way to help them.

While many of the suggestions might have eluded traditional hospital planners, they made a lot of sense. For example, some people wanted massages as a way to calm patients and acclimate them to the hospital. Now we are thinking of providing hand or foot massages to ED patients. In addition, Hmong people saw no familiar faces when they come to the hospital, so we are planning to station Hmong greeters there.

What comes next
Many solutions could be undertaken at little expense. For example, our translating advance directives into Hmong was at a very small cost. Also, the chemical dependency patients told us they needed positive distractions such as books, so we organized donations of books.

More suggestions are under review and we plan a lot more forums in the future. We are in the process of reaching out to more constituencies, such as employers who pay healthcare bills. Local governments, for example, want more wellness programs, such as smoking cessation programs for its snowplow drivers.

This new initiative has created a great deal of trust inside the community. While people may expect more from the hospital than before, they also seem willing to give more in the form of donating their time as volunteers. Although the fall initiative was not meant as a marketing tool, our census has been rising and when this was being written, all hospital beds had been full for two weeks. There is also evidence that people who have stronger ties to the hospital are more likely to pay their bills and are less likely to sue.

CEOs at several other hospitals have been contacting me about our initiative. We are very happy with the results. What we have learned from the community has the potential to fundamentally change the way we operate and help us thrive in the future.

Stephen F. Ronstrom has more than 25 years of hospital leadership experience, having served for the past 12 years as an executive in the Hospital Sisters Health System. He is currently president and CEO of the Hospital Sisters' Western Wisconsin division, which comprises 344-bed Sacred Heart Hospital in Eau Claire and 193-bed St. Joseph's Hospital in Chippewa Falls. Learn more about Hospital Sisters Health System. https://www.hshs.org/home.aspx

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