Changing Culture at a Challenged Hospital: Q&A With Dr. Sonia Mehta, CEO and CMO of Chicago's Loretto Hospital

When Sonia Mehta, MD, MBA, took the helm at Loretto Hospital in the Austin neighborhood of Chicago in November 2012, she inherited a non-profit community hospital that has had its fair share of challenges since it opened in 1939.

In the early 1980s, Loretto had to stop delivering babies at the hospital due to rising costs. In 1990, the hospital received a federal citation which listed issues such as unsanitary surgical suites and outdated medication, according to a Chicago Tribune report, and was poised to lose its Medicare and Medicaid funds. The hospital was found to be in compliance with federal regulations later that year. More recently, the hospital again faced losing Medicare and Medicaid funding after a patient stabbed another patient in June 2012. CMS accepted the hospital's safety correction plan a month later.

After making it through all of that, today, the hospital serves more than 33,000 patients each year. It is the only hospital in Austin and is the largest non-governmental employer in its community.

Though some may see the hospital's unstable history as a turnoff, Dr. Mehta was drawn to the hospital for that very reason, and she became Loretto's CEO and CMO. Here, Dr. Mehta shares the plans she has to improve the hospital and how her experience will help her succeed.Sonia Mehta, CEO and CMO of Loretto Hospital

Question: You joined Loretto Hospital in November from the Hospital Sisters Health System Illinois/Wisconsin Medical Group. What attracted you to the job?

Dr. Sonia Mehta: It's no secret that Loretto Hospital has faced multiple challenges over the past few years. However, I didn't just see the challenges; I realized that there was a lot of potential and opportunities at this institution. I wanted to be the catalyst and a part of the positive change and success of the hospital going forward. I couldn't miss out on that opportunity. That was one of the biggest reasons I pursued this opportunity.

Q: What has been your top priority since you took the helm at Loretto Hospital?

SM: I have multiple priorities. The top priority is improving quality and patient satisfaction. I want Loretto Hospital to be the hospital of choice for the community. In order to achieve this, we must create a patient-centric culture — one where patients always come first! Loretto Hospital has always been in survival mode, and it is time we become proactive in our planning and operations so that we can create an atmosphere of quality and excellence.

The second priority is physician alignment. We can't deliver quality care unless we have quality physicians.

The third is we need to get better at meeting the needs of the community. If patients are going somewhere else for their care, I want to understand why and see how we can meet those needs to make it more convenient and keep them closer to home.

I want to move the organization forward to the next level in multiple areas. However, I would say those are the top priorities for me.

Q: You serve as both the CEO and CMO of Loretto Hospital. How do you split time between the duties of both roles?

SM: I joke about it, but I work as a "whole" person. Any healthcare leader needs to understand both sides of healthcare: the clinical side and the administrative side. I wear two hats in everything I do, and I always look at things from both perspectives.

Because I have a MBA and a MD coupled with years of experience, I understand that finances are as equally important to keep the hospital viable as our patient care and quality is. If patients come in and you don't have operational efficiencies, you're not going to survive. Being at a smaller hospital gives me the flexibility to be more involved in and in tune with what's happening in every department, thereby making the decision making process a lot easier. My leadership and clinical expertise are interwoven, so I don't split my job as a CEO and CMO.

Q: How does your experience as a physician influence your leadership style as an executive?

SM: Well again, because of that experience, I look at administration and operations from all standpoints: the patients, the employees and the physicians.

All of my decisions really involve everyone's input. I'm out there talking to people. I try to understand the ideas that our employees have, especially those of our front-line staff such as the nurses and receptionists. I also like to talk to the patients to get their advice on what we can do to create better quality and a positive patient experience.

Over the years, when I was strictly practicing medicine, I noticed that the administration doesn't always understand the day-to-day aspects and responsibilities of the first-line caregivers. It's valuable that I stay grounded and in-touch.

To me, my experience has really shaped me over years. I never forget that in the business of medicine, lives are at stake. I want to make sure going forward that we always put our patients first and that we offer the best care possible because people trust us with their health and wellbeing.

I'm also planning to continue practicing medicine as things settle down here. I will probably spend a few hours a week doing patient care. Of course, right now is not the greatest time for me to jump into that, but eventually I'm planning to.

Q: What is the greatest challenge you've faced as a hospital executive, and how did you overcome it?

SM: One of my greatest challenges is implementing a change in culture. Even though there are other challenges that are equally as difficult; we know there's nothing easy about working out finances and succeeding in the struggling economy. But, working on a cultural change about what we think about what we do, why we do it and how well we do it is really tough. You need the full engagement of your senior leadership team and buy-in and participation from the entire organization.

Here at Loretto we're trying to create a cultural change. We're trying to make everyone accountable for their role in the lives of our patients and in the success of this hospital. Every time I've tried to change culture, I've looked at senior leadership and said, "Do we have the right people in the right places to bring accountability to their work?" We are a mission-driven hospital, we are not in a rich area and we do a lot of charity care. Unless you have the right mindset and believe in the mission and values of this hospital, you will never create that accountability, and having the right people is the key.

It takes 12 to 18 months to create a sustainable culture change. I took the first 90 days [at Loretto] to evaluate the senior leadership and key position holders. Now, I need to make sure we have the right goals and objectives in place. If we don't know what we're trying to achieve, we can't achieve it. Over next three to six months is the time when we get a clearer understanding of our vision and then give the staff the tools to carry it forward.

However, I must say that it's imperative that leadership maintains regular communications with their employees about the changes happening at the hospital. When you leave people out in the dark, you create an environment of fear and anxiety. We don't want anyone to feel left out or undervalued so we will take every appropriate measure possible to keep our people in the loop. We will do this through: employee town halls, one-on-one meetings, emails, etc.

Q: How do you plan to adjust Loretto Hospital's physician alignment structure as the competition for physicians grows due to the impending physician shortage?

SM: First, we're trying to build our primary care physician base by employing more hospitalists to provide better coverage and control length of stay, especially psychiatric hospitalists because we do behavioral health very well here.

Secondly, we're trying to align with federally qualified health centers and independent primary care physicians and specialists to improve our relationships in the community. Because we're not a rich hospital; we can't sustain a large employed medical group long-term.

Finally, we're going to create a better atmosphere conducive to healing and one where physicians love to work.

Q: Accountable care organizations have been spreading across the country. As a community hospital, how do you see Loretto Hospital fitting into that landscape?

SM: First, let me state that we are not planning on any merger. Currently we are a community-based, safety net hospital that serves Chicago's Austin community and the board of directors wishes for us to remain independent. We don't want to merge and be diluted. But over time, if situations get tough and we need to consider it, we may. We never say no in healthcare [and could consider a merger].

As it stands now there are no plans of doing that. We've been here for more than 73 years, and we've stood independent and we are not struggling. As long as we can stay independent and serve the community without compromising our standards, programs and services, we will.

However, there are two things we're doing right now. We're trying to align with other health systems to participate in their ACO, but I can't disclose much about that right now.

Until we align formally with other health systems, the second thing we're trying to do is create our own informal ACO-type structure by aligning with physicians, nursing homes, home health agencies, social services organizations and others so that all of the pieces are in place and the continuum of care is not affected.

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