Three hospital CEOs on the state of health care in NWI
Hospital CEOs care about the quality of service their hospitals give to patients. Earlier this month, local hospital leaders told The Times’ BusINess and health care advisory boards that they are constantly striving to improve their medical centers. And they worry. A lot.
“Everyone in the community needs to know folks just don’t get into health care unless they really care for people, and they don’t stay in health care unless they truly, deeply care for people” said Gene Diamond, regional CEO of Sisters of St. Francis Health Services (SSFHS). CEOs from Community Hospital, Methodist Hospitals, and Sisters of St. Francis Health Services sat down together and openly discussed a range of local issues—from H1N1 to physician shortages to patient safety.
Patient safety was a unanimous concern. In a collaborative effort to improve it, Community Healthcare System, The Methodist Hospitals, Porter Health and SSFHS formed the Northwest Indiana Patient Safety Coalition last July. The hospitals work together to increase communication and instate uniform procedures that increase the quality and efficiency of patient care. For example, the hospitals are making the colors of patient wristbands worn to identify conditions consistent at all hospitals. “For workers and physicians who work in different facilities, they won’t have to wonder if blue (means something different) for this hospital,” said Don Fesko, CEO of Community Hospital.
Uniformed coding for emergencies—such as Amber Alerts—is also in the works, Fesko said. “I think it would be easier if they make a standard protocol. It would be nice to have the same codes so when you hear them, you can take action at the hospitals.” Though the large-scale coordination between hospitals can be important, Diamond said the responsibility for patient safety ultimately relies on the people providing the medical care.
“It really takes a great (medical) team to achieve better outcomes.” He added that buying and using the latest technologies can only take hospitals so far. “Hospitals are very dangerous places,” Diamond said. “Each of these hospital systems competes with each other, so we’ve taken intense internal actions to promote patient safety.” The SSFHS hospitals break down the patient care process and teach and review it internally. “We want to make sure we repeat the good steps and avoid the bad steps,” he said, adding emphatically that everyone who works at the hospital wants to ensure that every patient is “aware of being loved.”
At Methodist Hospitals, hand sanitizers have been placed throughout the facility to help prevent the spread of communicable diseases, said Ian McFadden, CEO of the hospital system. The hospital is working to improve its system of patient identification and medication distribution as well. It’s basically ensuring that the patient is getting the right medication at the right time,” McFadden said. Methodist Hospitals and the SSFHS hospitals have both tried to address the issue of long emergency room waits as well.
“(The wait time) is not going to get any better under health care reform,” Diamond said. The SSFHS recently began stationing physicians at the front of their emergency rooms so patients can see a doctor right when they walk through the door. Diamond said an emergency room is like a welcome mat for the hospital—it creates a powerful first impression.
“(Patients) feel they’ve had a good experience by the time they get on the floor,” Diamond said. “The residue from that experience stays with them through their stay.” As a result, Diamond said St. Margaret Mercy hospital has seen its walk-out rate drop from 10 percent to three percent after putting physicians near the entrance.
“(Patients) can walk,” McFadden agreed. “They have other choices.” In the last few months, Methodist Hospitals has stationed about 10 greeters in its emergency room, outpatient surgery and other waiting areas to keep patients informed. “That way there’s someone for people to talk with, interact with and figure out what’s going on. Whether it’s (a greeter saying), ‘Now we’ve got x number of people back there, we’ll get you in (within) so many minutes,’” McFadden said. “If people know what’s going on, they won’t be out there stewing.”
In the future, McFadden hopes to improve care by having a computerized system of medical records. “Having an automated system with an electronic medical record where you don’t have papers to track or place—it goes miles in patient care,” McFadden said.
Fesko said similar efforts are going on at Community. Within the next two years, the hospitals are planning to use a new system of dispensing patients’ medications. Bar codes on patients’ wristbands would correlate to their prescriptions, he said. But patient safety is not the only thing causing hospitals to take action—aging baby boomers are creating cause for change too. There are more than 78 million baby boomers, according to 2005 U.S. Census data, and in the next five years hospitals will be seeing even more baby boomers as they age and need additional health care.
“I’m the oldest on the panel, and I intend to be a big burden on the health care system,” Diamond said with a laugh. Joking aside, Diamond said hospitals are looking at an aging population and are concerned. SSFHS is shifting its focus to chronic disease management and geriatric medicine to prepare for a larger volume of elderly patients, he said. The system also offers nursing homes and assisted living facilities. “Moving forward, we’re in a good position,” Diamond said. “We have a geriatric program in place that we’re sure is going to grow.”
Methodist Hospitals is focusing more on services utilized by the elderly as well, such as orthopedics and cancer treatment. “I don’t want to make light of this, but we’re probably going to see an increase in mental health (cases), probably Alzheimer’s,” McFadden said. “I think we’re going to be seeing a lot more focus on the specialties.”
At Community Healthcare System’s hospitals, hospitals will be tailoring services to meet the expectations and needs of baby boomers, Fesko said . . . “What we’ve learned of the baby boomers is they want convenience, control and value,” Fesko said. He continued saying that the hospitals will also be spending millions of dollars on labs and more robotic surgery technology to help compensate for an increase in patients and shortage in medical personnel.
By 2025, the U.S. is projected to experience a shortage of as many as 12,000 physicians, according to the Association of American Medical Colleges. If universal health care reform passes, there is a concern about whether the current physician population—which could decrease with a generation of doctors retiring—will be able to treat the impending influx of baby boomers in addition to the newly-insured general population. Diamond said the SSFHS—which has local locations in Munster, Hammond, Dyer and Crown Point—has affiliated programs with high schools, colleges and universities to foster student interest.
“We try to catch them fairly early,” Diamond said. “We believe if we catch them early, they’ll have a better chance.” Nationally, there are mal-distribution problems, especially with primary physicians, Diamond said. Luckily there is not a shortage of nurses in the area, Diamond said, however the average age of a nurse is in the late 40s. In the next five to 10 years a large portion of the region’s nurses could retire. “That’s a real concern for the future,” Diamond said.
Methodist Hospitals is trying to tackle the physician shortage problem by offering a residency program through Northwestern University. “Physicians who join residency programs locally have a greater chance of staying in the region,” McFadden said.
But it’s still difficult to attract talented doctors when medical schools can leave students with $200,000 in debt, Fesko said. “Family practice and internal medicine residencies are not full every year,” he said. “It’s harder and harder to get college students going into these fields.” With lower reimbursement rates from Medicaid and Medicare, law careers and Wall Street can offer more money.
And with universal health care reform on the horizon, Diamond added that those reimbursements could change again. If reimbursement rates continue decreasing, it could affect the care patients receive at hospitals. “We are here to catch patients in a safety net with the limited resources we have,” Diamond said. “We have the best health care in the world, but it needs structural change.”
In spite of health care reform or physician shortages, McFadden said the key focus moving forward is to deliver the best quality product. “There’s a lot of talk about a teaching center and trauma center . . . but our biggest concern is doing the best with what we have today,” McFadden said.
Moving forward, Fesko said he would like to see improved communication between the hospitals and more Hoosiers from Northwest Indiana staying in the region to get their care. “There’s still a large number of people who use Cook County to get their health care,” Fesko said. They need to give us a try. They live here and work here. We want to keep them here.”
As for hospital executives, Diamond said they toss and turn, sweating blood at night worrying about patients, the hospital and how to improve. “You worry about it constantly. It’s a constant source of stress.”
Note: A follow-up summit with the three hospital CEOs from Porter and LaPorte counties is scheduled for first quarter 2010.