Shifting From a Hospital-Based to Community-Based Mindset: Q&A With Valinda Rutledge, CEO of CaroMont Health

Valinda Rutledge was named CEO of Gaston County, N.C.-based CaroMont Health System, parent of Gaston Memorial, in Aug. 2009, resigning her previous position as CEO of Bon Secours St. Francis Health System in Greenville, S.C,  part of the national Bon Secours system. The unusual move, says the former nurse, gave her a greater opportunity to impact the health of an entire community — a goal she has had for her entire career. Here she discusses her achievements at CaroMont, the system's plan for the future and why hospital leaders need to take a community-based approach to health, rather than just a hospital-based one.

Q: Gastonia is a very different community than Greenville and CaroMont a very different health system. What attracted you to your new position?

Valinda Rutledge:
A passion of mine throughout my life has been to improve health. I saw an opportunity at CaroMont to create an innovative health system that would improve the overall health of the community. The hospital has had superb quality for many years with clinical outcomes in the top 5-10 percent nationally and Magnet status. The clinicians and physicians are excellent, the board has a strong commitment to the community and there is tremendous community loyalty to the hospital. [Gaston Memorial] is also the only hospital in the county. We are the safety net, so if a patient is discharged and then readmitted, he or she will come right back to us. All of this creates a great foundation and a great opportunity for the hospital to move from hospital-centric to community-centric.

Q: Why is the idea of expanding the boundaries of a hospital's responsibility for health beyond its own walls so important to you?

VR: Hospitals have to move away from being hospital-centric to being community-centric, and health reform has created a greater impetus for that. Hospitals have to get more involved in the community and better understand its health status. It's not only an issue of health, but also, integral to the economy. On the local level, it's one of the fastest growing expenses for employers, which is especially challenging for small employers. Our county was hard hit in the 1990s by the loss of many textile jobs that used to support many of the residents of the community, and these jobs have since moved to other countries. Overseeing population health and keeping costs down is an important part of supporting the community and its businesses.

Q: What are some of the things you've done at CaroMont so far to move toward this idea of improving the health of an entire community?

VR: Almost immediately, I began to implement the "triple aim" goals of better quality, better health for the community and reduced per capita costs. The goal related to community health was new to the system, and we came up with a new mission statement to reflect this new focus: To be a nationally recognized leader and valued partner in promoting individual health and vibrant communities.

One of the first things I did to move us toward meeting these goals was to reorganize the structure [of the health system]. We created a position of executive vice president of operational integration, EVP of clinical integration and a vice president of wellness and VP of chronic disease. I also developed six physician-led councils (organized by service line, including primary care) to examine hospital readmission rates. The councils were unique because they also included community leaders, such as public health department officials and human resource representatives from employers in the area.

The main purpose of the restructuring effort was to create a methodical approach to analyze data on the community's health and begin to determine ways to improve while reducing costs. In order to impact the health of a community, you must  look outside of the hospital.

Q: Analyzing health data and developing evidence-based protocols involves a great deal of physician improvement. Did you have any difficultly getting your hospital's physicians on board for this type of commitment?


VR: While we employ about 60-65 percent of our physicians, 35 percent are not employed. We have made a commitment to support these doctors within independent practice, and we need them to commit to improving population health as well. Three of the six physician councils are led by non-employed physician chairs. We also recently started a year-long course for physicians on how to analyze disease data, identify trends and become more facilitative leaders. Forty-seven physicians (both employed and independent) voluntarily enrolled in this year-long course.

Q: What are some initial steps hospitals can take to move toward the goal of improving population health and better controlling costs?

VR: First, hospitals have to partner with physicians and get them on board. They are the only ones who can help redesign the processes of care. Hospitals need to provide leadership and educational opportunities for physicians on population health and use data to drive their decisions.

Hospitals should also partner with community agencies, such as the health department and employers. They should be seen as equal partners. Hospitals shouldn't think they have all the answers. Partnerships should be respectful of the existing knowledge and expertise of these agencies. Also, hospitals need to be part of the solution to fix the economy and not part of the problem. We need to be willing to reduce costs, especially to employers, and we need to do that even if it means taking a financial hit. We should do it because it's the right thing to do as community leaders.

If the hospital is a large employer in the community, as CaroMont Health is, it can first focus on improving the health status of its own employees. Our CaroMont leadership team now receives incentives for meeting certain benchmarks for employee health. For example, leaders will receive a financial incentive this year if a certain number of employees with chronic disease enroll in a disease management program. Next year the incentive might be to reduce the average blood pressure reading or BMI (Body Mass Index) for our employees by a certain percent.

Hospitals have to focus on chronic disease. Ninety-six percent of Medicare dollars are spent on patients with four or more chronic diseases. The answer to reducing costs comes down to better management of chronic disease, which requires a more integrated system of care.

Q: You have been in healthcare for 30 plus years both on the clinical and administrative side. Given this breadth of experience, what have you found most important to keep in mind for successfully leading a hospital?

VR: Leadership, for me, means providing a vision and always being a dealer in hope. We get so busy in the day-to-day work that we sometimes lose sight of why we're doing what we do. One of my favorite poems, "The Contract" by William Ayot, talks about how leaders are there for people when they have doubts. They give us trust and only ask that we stay true. "Staying true," for us, means being true to our mission and our community. As leaders, we have to be good stewards of that mission. For a non-profit healthcare system, we have to continue to work on improving the health status of our community, which can only be done by rising up and taking on hard issues.

Learn more about CaroMont Health.




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