Mastering the Matrix of Healthcare: Q&A With Syd Bersante, President of St. Joseph Medical Center in Washington

Syd Bersante, RN, has led St. Joseph Medical Center in Tacoma, Wash., as president since November 2007 after joining the hospital's parent company, Tacoma-based Franciscan Health System, in 1990. With 361 beds, St. Joseph is the flagship facility of Franciscan — a subsidiary of Englewood, Colo.-based Catholic Health Initiatives — and has undergone a flurry of development in recent years, with new telemedicine initiatives, electronic medical record implementation, a neonatal intensive care unit and other hospital-wide initiatives.

Here, Ms. Bersante discusses Franciscan's "matrix" style of management, why she believes the idea of lonely executives is old thinking, and how hospitals can instill patient-centered care in their capital investments.

Question: A heart valve clinic and neonatal ICU opened at St. Joseph within a month of one another — that's a lot of development in a short time span. Can you tell me a bit about those developments? What other capital investments have occurred under your tenure?

Syd Bersante: We received state approval to create a Level III NICU to complement our Level II special care unit. This involves a construction project to create the unit, which will begin in February 2013. More than a capital investment, the NICU will complement the OB/Gyn services we offer. We provide the most deliveries in the area — more than 5,000 babies are born at St. Joseph and two other hospitals in the Franciscan system every year. [The NICU] piece was missing from our continuum of care for the entire Franciscan Health System. It will support our focus on patient-centered care as we won't have to transfer as many babies from St. Joseph for high-level care.

We're very proud of our new heart valve clinic. It's an additional service to our full suite of cardiac services at St. Joseph and the Franciscan organization, and reflects our desire to provide comprehensive, patient-centered care. St. Joseph is the leading provider of heart-related surgeries and other cardiac services in the region. The new clinic allows patients to come in through their primary care physician for diagnostics or surgical consultation all in one place. We all want to go to one place to be evaluated and receive a care plan through one visit. We don't want to be routed one day through diagnostics, another to a physician, and so on.

We're also constructing a new medical building on the St. Joseph campus that will create destination care centers for several of our primary care and specialty care providers in the Franciscan Medical Group. Services and programs that complement the destination center practices will be in the new medical office building, so they will all be connected — physician practices, diagnostics and other specialists like neurosciences, women's care and orthopedics. The other big investment we've made is our surgical robotics program, which we started in 2008 with urology and gynecology, but have since expanded to bariatrics, general surgery and thoracic surgery.

Q: St. Joseph is also in the midst of electronic medical record implementation, correct? How has that gone so far?

SB: This is a major system-wide initiative that requires a lot of organizational attention. We're scheduled to go live in April 2013 with Epic as our clinical information technology platform. It's my responsibility to help articulate the vision for this initiative so our staff are engaged and supportive, and to ensure we have group project management and structure. It's also my role in operations to ensure there is good coordination around this initiative so we are able to maintain our high standard of patient care during the transition to an EMR.

Q: St. Joseph is expanding its telemedicine offering. How do you think hospitals can broaden telemedicine strategies while maintaining patient satisfaction and experience?

SB: I think telemedicine helps with patient satisfaction and the overall patient experience. Franciscan Anytime is the telemedicine initiative we launched in 2010 for St. Joseph employees, and we expanded it to all Franciscan Health System employees in January 2011. It's an enhancement beyond regular office hours and allows people to access medical experts via phone and webcam during the off-hours, which enables them to avoid unnecessary and costly emergency department visits.

We've prevented about 165 ED trips with an estimated cost savings of $200,000 thus far. Also, we recently expanded the telemedicine service to several of our primary care practices to give their patients an alternative for after-hours care. We are working to extend the service further so that telemedicine can be available after hours for patients of every Franciscan primary care practice.  

The other thing we're doing with telemedicine is in the area of neurology and mental health. It's pretty well known that there are challenges due to a lack of physician specialists. We've found that we can connect specialists via telemedicine to provide consultative services at Franciscan's community hospitals. That's been very positive for physicians and their patients at those other sites. Physicians can access consultative services in real time and address issues quickly. This reduces the need to transfer patients from our community hospitals to St. Joseph, which creates a more positive experience for patients and their families. Additionally, we are working with psychiatrists on our medical staff so they can use telemedicine technology to serve their patients.

Q: Many leaders have brought up the topic of loneliness in the C-suite — they often feel isolated and unable to freely bounce ideas around. How do you feel about that?

SB: I think loneliness in the C-suite is kind of old thinking. Our "matrix" leadership structure promotes a team approach, in which executives can openly discuss issues and concerns. I'm president of this facility and there is a counterpart at each one of our facilities, but each one of us is also responsible for service lines that span the entire organization. [Note: Ms. Bersante oversees the cardiovascular, women's care, diagnostic imaging, wound care and pharmacy service lines for the health system.]

We interact as a team with our counterparts on a variety of issues affecting our service lines. We have twice-a-month meetings and all-day retreats once per month, where the entire team comes together to work out strategies and share ideas. We have a great culture of trust, in that we can be vulnerable at times and ask for help about things that are particularly troubling.

Another thing that helps is our succession-planning program in which we identify managers, directors and associate administrators who are up-and-comers in our organization and have the potential for larger roles. We take them through a year-long process in a leadership development and use them as sounding boards for proposed changes we want to make as executives.

The other connection is with Catholic Health Initiatives. Twice a year, CHI executives gather to identify areas of concern, walk through something problematic and find new best practices. We build relationships and connections on a national level.

Q: Can you describe one of the most memorable risks you've taken and what came of it?

SB: My transition from being a clinical director to taking on a chief operating position in a facility 16 years ago was a huge transition. At the time, it seemed like a major risk because I left something in which I was very accomplished, well-thought of and successful to do something very different in terms of how I lead. I went from a role very focused in clinical care to a role with a broader reach in terms of the work you do and knowledge in how to apply different skills. There were a lot of unknowns for me. I've since learned to not be afraid of taking on, or doing, something new, because quite frankly, that's the way we grow and learn.

Q: Looking back, what advice would you offer yourself on the first day of your job?

SB: I think it's important to start making connections with key leaders in the organization: the physician leaders, staff leaders, managers and directors. Start to outline who those individuals are, because those are the people you'll start building relationships with. They also help you get a feel for the culture and how things really work. From there, connect with employees and begin to understand opportunities for improvement within the organization.

More Articles on Hospital Presidents and CEOs:

How a Banker Turns Around a Struggling System: Q&A With Carlos Migoya, CEO of Jackson Health System
Facing Challenges With Meaningful Affiliations: Q&A With The Mount Sinai Medical Center CEO Dr. Kenneth Davis
Unafraid to Change Her Mind: Q&A With Dr. Melinda Estes, CEO of Saint Luke's Health System

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