How this community hospital addresses margin pressure and delivers standout specialty care

Amid increased margin pressure, leaders at Greenbrae, Calif.-based Marin General Hospital have prioritized strategic partnerships and investment in leading-edge technology to ensure maximum clinical efficiency and establish the hospital as a regional standout for specialty care.

Mark Zielazinski, Marin General Hospital's chief information and technology integration officer, and Ken Cortes, director of imaging services at the hospital, spoke with Becker's Hospital Review about what they are doing to help their facility transcend the standard capabilities of a community hospital.

Editor's note: Answers have been lightly edited for length and clarity

Question: What are the top challenges you face?

Ken Cortes: Finance is always a concern, as is having the ability to get the right technology within the available budget. There's also the ever-changing reimbursement landscape, and the annual changes CMS makes each November regarding the procedures they will or won’t pay for, so we are always trying to forecast for the next year.

Mark Zielazinski: Like most hospitals in the U.S. today there's been relatively strong pressure financially and we've seen pretty significant degradation on our margins. We've been a relatively successful hospital and we have a major construction project underway but before the building is done we have some cultural and operational things we need to address so when we move we are successful.

Q: How are you using technology as a competitive advantage?

MZ: We formed a relationship with Philips some years ago that has given us access to technology that's really strengthened some departments to the point of becoming regional standouts. We have a state-of-the-art cancer center and are rapidly becoming one of the most successful structural heart programs in northern California. Technology is a big part of that.

KC: We've leveraged technology to improve capacity and the entire patient experience at our comprehensive breast center. Philips helped us design the layout of the space in a patient- centered and efficient way while also providing us with the necessary technology. We are a small community hospital but we do a lot of big hospital things.

Q: How do you prioritize technology investments at a community hospital?

KC: I think you have to do your homework, because physicians see new technologies at larger academic institutions and want them, but that may not always make sense for us. You do have to work with physicians to understand what the goals are for their requests and then there's a lot of prioritization based on budget and future programs.

MZ: We spend a lot of time trying to figure out where are we going to be in the next five years and making sure our investments are going to lead us that way. I think there's a massive shift from fee-for-service into some kind of newer payment system and that's coming at the same time that patients are demanding more personalized interactions. We are expanding our brick-and-mortar presence, but in the future that will become less and less critical to our organization. Capturing patients virtually and communicating with them at a different level is a priority for us.

Q: How did change management and new ways of thinking/working impact the hospital?  

MZ: We just came from a meeting looking at how we can get better and change our culture to make sure it's more agile. We focus on three critical relationships; taking care of yourself, your colleagues and your patients. We use that model to build our culture and dictate how we interact with one another and become less stovepiped as an organization. We've been at it a little more than two years now and have not just applied these principles to our culture but have examined process and the operational side of change management. Our financial situation has been on this very slow glide path down, and it's taken almost a year and a half for our margins to erode. We've looked to find a way operationally to change and manage our processes such that we can pull out of that slow descent and hopefully forge a path up. As we look at change management it's essential to examine work processes, workflow and operational efficiency.

KC: We've instituted some important initiatives in the last two years. Our comprehensive safety program holds meetings every day with senior leadership to understand essential safety issues that have occurred in the last 24 hours. The relationship-based care initiative began a year and a half ago, and we started with shared governance model that heavily involves front line staff and avoids silos, which would not have been possible without change management.  

MZ: We've also started to hold lean management trainings and apply lean processes to our work and to me lean is a change management strategy. When you combine that with the cultural work we've been doing it's been a powerful mover for us. There's not one single silver bullet process or program, but a culmination of a number of activities to move the organization in a number of different ways.

Q: How can partnerships play a role in achieving your goals?

KC: Our lean management training came through our partnership with Philips. Philips doesn't just offer technology, but leverages its size to get us where we wanted to be by installing a culture where we're all rowing in the same direction. Many vendors are only interested in a transactional relationship, but with Philips, we have a partnership in the truest sense of the word. They have two full time employees on our campus to help daily with all our partnered initiatives.

MZ: We're now in year three of our partnership with Philips and it took us two years to pick a partner. While it was heavily focused on diagnostic imaging equipment, they've brought so much more to the table, including clinical and management education, consulting services, lean trainings as well as some capacity planning. When we began, we had no idea that a 15-year technology management plan would look like this this, with somebody who's not just interested in the next piece of equipment, but so much more. They look at things we can be doing to improve processes across the facility and meet regularly with different committees, senior leaders, and C-suite executives to examine our tech management plan and ensure we are well positioned for the future.

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