Hospital executive roundtable: Accomplishments, challenges of 2014

This year has been another one full of change, challenges and opportunities for provider organizations and those who lead them. Here, three hospital and health system CEOs and chief administrative officers reflect on the year and the lessons they learned along the way.

Participants:

  • Aaron E. Glatt, MD, Executive Vice President and Chief Administrative Officer of Mercy Medical Center (Rockville Centre, N.Y.)
  • Kenneth Paulus, CEO of Allina Health (Minneapolis)
  • Michael Young, President and CEO of PinnacleHealth System (Harrisburg, Pa.)

Question: Looking back at 2014, what was your biggest accomplishment as a healthcare leader?

Dr. Aaron E. Glatt: I'm very proud of our quality improvements — we are continuously moving upward? in our core measures and seeing almost perfect compliance with all objective measures of care. We were a Joint Commission Top Performers on Key Quality Measures; that's something we're very proud of since only a small percentage of hospitals earn that accolade. The overall quality of our hospital is what makes me the proudest. We are continuously focused on improvement and patient satisfaction. Physicians, employees and administrators work in concert to make this a highly recognized and patient recommend hospital.

Kenneth Paulus: We expect to finish 2014 on plan, but only achieved that outcome through aggressive expense reduction early in the year. Our biggest accomplishment is the real-time improvement in our performance, a reflection of the leadership and teamwork displayed in the face of a rapid cycle improvement effort. The days of long planning cycles is behind us — healthcare has become a very volatile and dynamic business that is requiring more robust and proactive leadership.

Michael Young: Our biggest accomplishment was completing about 10 years' worth of innovations and advancements in one year. We opened a brand-new hospital, a new cancer center and bought a rural, community hospital. We also formed an accountable care organization that has 40,000 covered lives, renovated our cardiac ICU, and we started the development of an affiliation with Penn State Hershey. We completed these initiatives while making quality improvements in sepsis, readmissions and chronic heart failure and maintaining infection rates that are among the lowest in the state.

Q: What was the biggest challenge you encountered in 2014? 

AEG: I would say now that would be Ebola, preparing and trying to deal with a potential case. It has been on our minds for months. In the middle of the summer, we posted signage asking patients to let us know if they had traveled to West African countries, and we have a triage system in place. We're trying very hard to prepare for any challenges an Ebola patient might present, like making sure staff are safe and protected, patients get good care and the facility is respond effectively and efficiently. We studied Ebola guidelines and are staying abreast of any changes. I'm proud of the staff, they are dedicated and want to succeed and do well.

KP: [This year] proved to be a very dynamic and volatile year for us. We started the year with soft volumes and little improvement in charity care, contrary to our expectations from the Affordable Care Act. We responded to this challenge by reducing expenses proactively to offset these financial pressures. The second half of the year has proven to be very different, with volumes and charity care improving. Volatility of activity and a change to seasonality for our hospital business has become a bigger part of how we run our business.

MY: In light of all that we accomplished, our biggest challenge was keeping everybody focused on what they needed to accomplish individually. It wasn't just what we were doing as a system. It's a pretty dramatic time in healthcare right now. Keeping people focused on the task at hand was quite an accomplishment during the wave of mergers, expansions and consolidations in the industry. And there are new competitors in the marketplace and new payment models. Being able to achieve what we achieved among all of the changes in the greater marketplace is remarkable.

Q: If you had to choose one event from 2014 that had the biggest effect on your hospital/health system, what would it be and why?

AEG: I think it would be our continued success in making the hospital fully compatible on an EMR. We went to a full EMR in 2013 and have seen tremendous challenges and opportunities since. We're improving patient safety in many ways and have been addressing other issues that going to a full EMR brings for more than a year. We accomplished meaningful use and are now dealing now with second stage, which brings major changes in the way the hospital functions. We have a team of extremely dedicated managers who are pushing the agenda down to the individual staff member level. The staff is the biggest advocate of doing it right. They are engaged and offer suggestions and ideas to improve our hospital and share best practices across the system. So, the EMR has probably had one of the biggest effects on the hospital.

KP: The launch of the healthcare exchange was a shot across the bow for healthcare costs and pricing. In our market, we experienced an insurance product price war, with pricing driving significant market share movements. Aggressive pricing was tied to narrow network products which are growing rapidly. 

MY: Our biggest event in 2014 was the opening of the new West Shore Hospital on May 19. Our system is the rare health system, opening a new hospital, which allows us to coordinate our care in the western portion of our service area. Patients west of Harrisburg were diffusing into many different providers, so it was difficult to keep them in our continuum model without the West Shore Hospital. The hospital incorporates patient-centered technology, including a cutting-edge IT system connected to ID badges, so when a nurse or physician walks into the room, it displays his/her name on an in-room monitor. The community acceptance has been tremendous. About 75 percent of the hospital's employees are new employees; we have extraordinary new talent blended with strong existing talent. On day one, it had a tremendously positive culture. And the new hospital is an economic hub for the county, attracting more business to the area.

Q: What was one lesson you learned this year that other healthcare executives could benefit from hearing?

AEG: It would be to try to listen very hard to what my staff is thinking and feeling. Like with planning for Ebola — I listened to their concerns. Listening to physicians, staff and patients provides the best education you can get. While I may ultimately not be able to always agree with them, I try very hard to understand their position and find ways to address their concerns or issues. There is always a learning curve for me, and I think for most people in a senior leadership position, and the single best tool we have are our ears.

KP: Managing change, accelerating the pace of decision making, and focus on the "vital few" have become important learnings for us. That, combined with the need to lead with two perspectives in mind — short-term performance improvement and long-term strategic investment and positioning. One without the other will be inadequate.

MY: Never underestimate how much your team can accomplish. So many great things happened in our system this year, and while all those things were underway, we still hit our targets for growth, finances, patient satisfaction and quality. People are generally nervous about getting out of their comfort zones, and it's the CEO's job to help them through that until they have a good handle on how much they can achieve.

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