During the Christmas holidays, Thomas Royer, M.D., then the new interim CEO of Parkland Health and Hospital System in Dallas, TX, played piano in a lounge for senior citizens because it was his annual tradition for 45 years, and he wasn't about to stop now—even if some may have felt he was tickling the ivories on the deck of the Titanic.
Even with the holiday mood, he was mindful of the difficult job he had taken on. During those early days as interim CEO, he met with hospital leadership teams, employees, and visited the inpatient and outpatient units as part of the task he had voluntarily assumed: to right the sinking Parkland.
Royer, who was named to the interim leadership post on December 1st, has been overseeing the safety-net hospital as it works to overcome dozens of deficiencies identified by the Center for Medicare & Medicaid Services.
These were shortcomings that the federal agency last year deemed so dire as to create an immediate and serious threat to patient health and safety. At risk were millions of dollars in Medicare and Medicaid payments.
After several months on the job, Royer remains unfailingly polite, and willing to talk about Parkland at a time when many of his peers in similar situations, might have been more tight-lipped.
"Transparency" is his watchword, says Royer. Over the last several months, the 70-year-old has been working 14- to 16-hour days, cleaning house of employees, restructuring physician and nursing teams and navigating political storms. His six-month contract expires in May, but he's hoping for a six-month extension to finish the job he started.
"I'm energized and committed" to improve Parkland, Royer says, telling hospital administrators: "I'm willing to stay as long as the board wishes to support me in this role, to help patients, staff, and physicians. I'm focusing on what's important and I think we are making improvements. I believe we will be very successful over the next six to nine months. I find it very rewarding."
Royer is leading the safety-net system as it works toward compliance to maintain eligibility for an estimated $417 million in annual Medicare and Medicaid contracts.
CMS ordered a review in July 2011 of the entire hospital facility after identifying dozens of deficiencies deemed so serious as to create an immediate and serious threat to patient health and safety. In September, Parkland and the Dallas office of the Centers for Medicare & Medicaid Services signed a systems improvement agreement, which requires Parkland to be compliant with all CMS rules and regulations by April 2013.
The hospital system hired the consulting firm Alvarez & Marsal Healthcare Industry Group to guide it through the systems improvement agreement process. A 300-page gap analysis report prepared by A&M detailed ongoing deficiencies, including systemic issues in the role and organizational structure of nursing and nursing practices. Royer has said that about 75% of Parkland's problems involve inconsistent nursing practices across the system.
Royer took over Parkland at a time of his life when other physicians his age would be fishing, playing with the grandkids, or soaking in the sun. In 2011, the surgeon had just stepped down from being president and CEO of Christus Health, where he held the top job for 14 years. Previously, he served as Chairman of the Board of Governors of the Henry Ford Medical Group and Senior Vice President of Medical Affairs of the Henry Ford Health System in Detroit from 1994 to 1999.
Royer says he wants to help Parkland plan for his successor as well. "Obviously, to create permanency (the hospital) needs to recruit a permanent CEO and a person who is a lot younger than I am. I am willing to help train that person, and help in transition."
Before taking over as the interim CEO at Parkland, Royer says he was in the midst of "semi-retirement, doing some speaking and working on a book." He says he essentially completed the unpublished book, named "Dr. Tom's Learnings," about his views on leadership, when the opportunity presented itself to take over the interim role at Parkland. While Royer used the word "opportunity," some would choose a different word for jumping at the chance at being interim CEO at Parkland.
"Colleagues encouraged me to throw my hat in the ring for the interim CEO role. I did that because I felt that the mission for Parkland is so important—caring for the most vulnerable—and I felt that Parkland is such an important critical access hospital, not only for the patient population, but for all of Dallas."
Royer felt from the beginning he was a match for what he needed to do. "I certainly took the opportunity to read the CMS report and original report. I didn't feel there was anything (that) I was not unfamiliar with," Royer says, "working with a team to put into place action plans to build the corrective action process, building on all that success."
Parkland holds a historic bookmark in a tragic page of American history. For Baby Boomers growing up, the name Parkland resonates as the hospital where John F. Kennedy died following his assassination on November 22, 1963. For those with exceptional memories, it might be the first hospital name they remember as kids growing up.
Royer sees Parkland in another light—today's light.
"The volumes are usually near or at peak," Royer says. "Just last night, we had 200 people in the emergency department to be seen. We had to go to total diversion because we had no beds."
"This is a very large institution, very large and complex," he says. "I've never seen sicker patients in my life, with the comorbidities we have here."
Of course, clinical challenges are at the heart of what has gone wrong at Parkland, with physicians also playing a role, especially with documentation issues. Some physician issues have been forwarded to a "peer review" committee, Royer says.
Another area that the hospital wants to improve is the relationship with UT Southwestern, whose medical students serve Parkland. The hospital will improve its mentoring and coaching programs, he says.
Royer emphasizes the importance of carrying out a "strong leadership program" at Parkland, as well as improved internal and external communications. He has initiated leadership and employee forums in which he eventually hopes to meet all of the hospital's 9,000 employees, including 1,600 physicians.
That's a tall order for one leader in a short amount of time, but he tries to keep it personal. When he's introduced to staff, Royer asks to be called Dr. Tom. When he left Christus, he wrote his books about leadership and teamwork. "I decided to record my 'learnings' in my quiet time," he says.
To excel at leadership, "you have to have passion. In order for me to hone my skills as a better leader, I've also become a better person, a better parent, spouse and better friend. The greatest 'learning' for me is that popularity is not parallel with good leadership." In taking on leadership in that way, "it's worth it," he says.
Even at Parkland.
More HealthLeaders coverage:
Parkland Dismissals Linked to Patient Safety, Accountability
As CMS Approves Parkland's CAP, Board Chair Resigns
Parkland Keeping Consultant's Analysis Under Wraps
Joe Cantlupe is a senior editor with HealthLeaders Media Online.
