The union-management animosity at Holy Family Hospital in Methuen, MA, did not end with last July's vote by nurses to join the Massachusetts Nurses Association/National Nurses United.
The National Labor Relations Board has taken up a complaint that a veteran nurse at the hospital was fired last year by Holy Family's parent Steward Health Care Systems, allegedly for her role in the organizing effort. An administrative judge will hear the complaint on Feb. 14.
Steward Health Care Systems denies the allegation and has issued a statement saying that "participation in union organizing activities played no role in the decision" to fire nurse Mary Ramirez, 61, who'd been at the Holy Family for 18 years.
These two narratives could not be farther apart. MNA/NNU calls Ramirez a martyr for the cause. Steward alleges that Ramirez endangered the life of a patient and slyly hints that she may have had a drug problem.
Steward says Ramirez was fired "because she intentionally changed a doctor's orders, committed an intentional medical error, and failed to enter the fact that she administered a powerful narcotic (morphine) into a patient's medical record. Ms. Ramirez admitted these facts to a fellow nurse, who then reported her actions to management."
Steward went on to claim that Ramirez's "intentional change to a doctor's orders, falsification of a medical record, and attempted cover up, combined with the fact that she had been previously placed on probation for two years by the Board of Registration in Nursing for diverting patient medication for her personal use, were the reasons for her termination." Along with terminating her employment, Steward also reported her actions to the Board of Registration in Nursing.
The fight has gotten so ugly that the two sides can't even agree on a name. MNA/NNU refers to Steward Health Care Systems as Cerberus-Steward Health Care to draw attention to the private equity firm that has bought 10 Massachusetts hospitals in the last 18 months.
The fight at Holy Family has become so toxic, and this is seven months after the union vote, that it is easy to forget that this is a hospital and not a tire factory or a rendering plant.
Probable Consequences
How will all of this play out? If it's anything like labor disputes at other hospitals, at some point the two sides will come to an agreement and some sense of normalcy will return to Holy Family. They'll issue media statements about working together to create a healing environment for the good of the community, let bygones be bygones, blah, blah, blah.
It is still worth asking about the long-term effects. Regardless of what an administrative law judge determines next month on the NLRB complaint (which either way will almost assuredly prompt an appeal by the losing side), scars will remain and public doubts, quite deservedly, will linger.
After reading the charges and counter-charges issued by Steward and the union—regardless of their validity—why would anyone in Methuen, MA, seek medical care at Holy Family Hospital?
Again: Based on what the two sides are saying about one another, the public in Methuen would be within bounds to see management as greedy and vindictive, and staff as angry, reckless and incompetent.
For that matter, at a time when skilled healthcare professionals are at a premium, why would any physician, nurse, or administrator take a job at Holy Family knowing they would be entering a volatile environment that is hardly conducive to healing or congeniality?
Unfortunately, the acrimony at Holy Family may be a harbinger. As the fight for diminishing healthcare dollars intensifies in the coming years, it would not be surprising to expect more labor strife in hospitals across the nation.
With less money, management will be less inclined, or able, to negotiate as margins shrink. Staffing and scheduling issues, compensation cuts, and quality of care challenges will create resentment and fear in the healthcare workforce, making the call to organize all the more appealing. Sophisticated, battle-tested healthcare labor unions such as the NNU will tap into that worker angst and enjoy even more success.
It is not hard to foresee the healthcare landscape broken into entrenched and polarized camps, with labor and management snarling at one another across a no-man's land. Caught in the middle will be the patients hoping to dodge the crossfire.
Healthcare continues to lead the nation in job growth, accounting for nearly for nearly one in five new jobs in the overall economy, Bureau of Labor Statistics data shows. Hospitals created 9,800 new jobs in December, and 89,100 jobs in 2011, finishing a strong year for job growth that saw 314,700 payroll additions in 2011. Here are some notable executive moves this week:
Healthcare created 22,600 jobs in December, finishing a strong year for job growth that saw 314,700 payroll additions in 2011. Healthcare accounted for nearly one in five new jobs in the overall economy, Bureau of Labor Statistics data shows.
Hospitals created 9,800 new jobs in December, and 89,100 jobs in 2011, more than double the 37,300 jobs hospitals created in 2010.
"Last year, 2011, was a very good year for St. Luke's Health System. It's going to be more of the same in 2012," said Dawn Murphy, senior vice president – human resources, with the 10-hospital St. Luke's Health System in Kansas City, MO, which has 9,500 employees.
"We are adding staff, particularly nurses, because of our facilities' expanding. We have seen volume increases and that have stimulated our hiring," Murphy said. "We are also an attractive employer and that has always helped us. People want to work here. We received over 100,000 applications for employment last year and we filled 2,000 positions."
Chris Roederer, senior vice president, human resources, at Tampa General Hospital, says the safety-net hospital saw some incremental job growth in 2011. External pressures, however, including a $20 million Medicaid funding cut from the state of Florida, have created a challenging fiscal environment that will impact hiring.
"It is going to be one of the more difficult years in our history, and we don't expect it to get easier. The pressure is going to continue," he said. "It's very unfortunate. We worked hard to get the reputation we have," Roederer said.
Roederer says TGH has targeted two areas for new jobs. "One has been positions related to the implementation and optimization of our electronic health records. Our IT area has grown substantially to meet that need," he says. "Another area has been in ambulatory services, our primary care centers, and even the employment of physicians."
"It has been reasonably difficult to fill positions but we are getting there," he Roederer explained. "There is substantial competition for primary care physicians and I expect that to be difficult in years to come as hospitals build their primary care networks."
"The IT positions with hospitals, the demand for that specialty and recruiting and retaining those people is going to be even more difficult. They are so specialized and in such high demand. We are finding that already," he said.
Murphy says the search for clinicians with IT competency will remain a challenge in 2012, especially with the coming of meaningful use requirements, and the upgraded ICD-10 medical coding.
"The IT department is always in search of the person who has the combination of clinical and IT skills with all that is going on with healthcare reform," she says. "That has been a focus for us over the past year: to recruit clinical people internally if they are interested in IT, and externally the people who have that magical combination of a clinical background with IT expertise."
"They are hard to find, which is why we try to grow our own when we can. For those of us looking outside the people with advanced skills in that area, it's a finite pool and we are competing for the same pool," she said.
Ambulatory services, which include physicians' offices, accounted for 59% of the job growth in healthcare. The subsector created 11,300 jobs in December and 187,000 jobs in 2011, after creating 166,100 jobs in 2010.
Physicians' offices created 19,000 new jobs in December and 67,600 new jobs in 2011, a near tripling of the 25,300 jobs created in physicians' offices in 2010.
BLS data from November and December are preliminary and may be revised considerably in the coming months.
More than 14.2 million people worked in the healthcare sector at the end of 2011, with nearly 4.8 million of those jobs at hospitals, and more than 6.2 million jobs in ambulatory services, which includes more than 2.3 million jobs in physicians' offices.
The 314,700 jobs created by healthcare represent 19% of the 1.6 million jobs created in the overall economy in 2011.
While there is nothing to indicate that healthcare job growth will slow in 2012, Murphy offered some caveats.
"With healthcare reform it is going to be incumbent upon all of us to be cost efficient," she said. "That is what we are looking at the next couple of years: How can we operate as efficiently as possible? Our reimbursements are going to be lower for the same care. The external pressures are on us to be cost effective. Even if we have a stable workforce, we have cost pressures."
In the larger economy, the nation's unemployment rate dropped from 8.6% to 8.5%—down 0.6% since August, and its lowest level since March 2009. BLS said the 200,000 new jobs created in December came from the healthcare, manufacturing, retail, mining, and transportation sectors.
Nonetheless, 13.1 million people were unemployed in December. The number of long-term unemployed, defined as those who have been jobless for 27 weeks or longer, was little changed at 5.6 million in December, and represented 42.5% of the unemployed.
The American College of Physicians this week issued a sixth edition of its ethics manual, the first rewrite since 2005.
The revised manual, published in ACP's flagship Annals of Internal Medicine, offers new guidance on longstanding issues such as end-of-life care, physician-industry relations, and ethics in medical research.
The manual also tackles emerging issues such as the role of social media and its impact on the physician-patient relationship, the growth and impact of the physician-employee model, treating celebrities in the age of Twitter, and physicians' dual role of serving patients' needs while also marshalling scarce or expensive healthcare resources.
"We're always facing challenging ethical issues," ACP President Virginia L. Hood, MBBS, told HealthLeaders Media.
"The common thread is to do what's in the best interests of the patient."
Hood, who also teaches at the University of Vermont College of Medicine in Burlington, says the growth of social media such as Twitter and Facebook has created potentially huge ethical sinkholes for physicians who don't use them correctly.
"The boundaries may be blurred as physicians and patients interact more via social media, which is really the public domain," Hood says. "People use these in a private way and in a professional way, and it is important for physicians to recognize that and don't let the ease of using these social media create problems with the patient physician relationship or the profession itself. We have to make sure our professional demeanor is maintained whenever we are in the public eye."
Hood says the growth in the physician-employee model may resolve some ethical issues while raising new challenges.
"It goes both ways," she says. "As people are employed and paid in a lump sum for a job they do, it may take away some of the incentives that the current payment system has to encourage more procedures than maybe are necessary. All of the incentives in the system support volume rather than value. Having people employed may take away some of those incentives."
"On the other hand it brings up other issues, such as the institution making demands on how physicians treat patients or what tests or medications they are allowed to use, or pressures to get people out of the hospital sooner because it's better for the institution's bottom line," she says. "There are institutional pressures that can be pressed on employed physicians that we have to be concerned about. It is a growing trend and there might be more about that depending upon how healthcare is paid for."
As medical resources become more expensive or scarce, Hood says physicians may find themselves caught between the demands of patients and the greater society.
"The ethics of professionalism revolve around doing good, doing no harm, allowing patient autonomy and social justice—the equitable distribution of limited resources so everybody has the same chance to get what is needed," Hood says. "These are the principles one has to balance and the decision to do things that may cost more when you can do something that costs less just because a patient saw something on television. We are obligated as physicians not just to try to make the right decisions but to help patients make the right decisions."
This article appears in the December 2011 issue of HealthLeaders magazine.
In our 2011 Industry Survey, 32% of leaders said they are very satisfied in their job, which is down from 42% in 2009 and 38% in 2010. While the overall satisfaction rate (combining satisfied and very satisfied) remains greater than 80% (it was 81% in 2011, 86% in 2010, and 87% in 2009), what do you think accounts for this lessening in intensity of satisfaction, and do you expect that to continue?
J. Scott Graham, CEO, Coulee Medical Center, Grand Coulee, WA
I have been in this position just over a year, and I’d be in that 32% who are very satisfied. But I think I understand why it is on the wane. A lot of it has to do with the external pressures out there that have continued to mount over the past several years. We are one of the most highly regulated industries out there, and that makes it extremely challenging to stay on top of all of that.
So people want the greatest amount of service for the least expense and, like in any industry, that is going to put on some pressure to be more competitive and efficient, and that is going to increase the stress levels.
Jeffrey E. Thompson, MD CEO, Gundersen Lutheran, La Crosse, WI
“I am not terribly surprised by it. I believe there are a lot of stressors going on in healthcare in general and in the environment around us. Stress brings out the good and the bad. If your organization is struggling, it will make it look worse. If your organization is really functioning well, the stress tends to allow your organization to shine.
A problem that I see a number of people having is they get paralyzed because of the huge uncertainty in the government, the insurance environment, and in the community. There are so many things up in the air. You need to look past all the things that could go in a different direction and ask, “What are the things we need to accomplish, and what are the precious few things that we really need to execute that are going to be good in all of those environments?” Regardless of whether fee-for-service hangs around or ACOs rally and charge down the road in the next year or two, an organization that can prove its quality, that has palpably better service and lower cost than its competitors, is going to do well.
People get nervous, and with good reason, because it is not clear where it is going to go. But that should not paralyze you into inaction. You can still make a plan for it.
George Kyriacou President and ceo, Hanover (PA) Hospital
A factor that may be more unique to smaller hospitals than larger hospitals is one that I have been dealing with: a real aversion on the part of both independent medical staff and some boards to take risks.
As a small independent hospital that wants to stay independent, we need to be at the leading edge—not the bleeding edge—of implementing new strategies, rather than on the second or third run when the opportunity may not be so great.
There is a tremendous amount of fear and a desire or belief that if we hold off, this is just a fad that will pass. I don’t believe that is the case.
It is understandable, but a small organization has to be fast moving and nimble to survive as an independent entity in today’s world of constantly aggregating models. If you aren’t willing to take risks and spend money to achieve financial advantage down the road, then you are going to be in a slow death spiral and in a position to be gobbled up by one of the big entities just because you couldn’t keep up with the world today.
Kimberly Bordenkircher, RN, BSN, MBA, FACHE CEO, Henry County Hospital, Napoleon, OH
Where we are: We are on the edge of what I call transformational change. The decrease in satisfaction will continue until we successfully navigate through that second order of change. The environment and the pace of change is unrelenting.
Where we were: A decade ago when I was in this role, there would be big initiatives coming down the pike and you’d have an opportunity to prepare for them and implement them and sit back and see if
they worked or not. You had some time before each big initiative. That is not the case anymore. The change never stops.
Where we are heading: We are preparing for a future that, to some extent, is completely unknown. We know that healthcare reform is coming. Exactly what that means and what it is going to look like we aren’t sure of, but we have to position our organization so we can survive and hopefully thrive during the change. It is hard to stay focused on what is really important.
Where to focus: What works for me is that in spite of all the regulation and healthcare reform, I try to keep my eye on what is important, and that is the patient. I try to connect all the initiatives and activity back to what is important for patients. Then I work really hard to keep my staff connected to that.
This article appears in the December 2011 issue of HealthLeaders magazine.
Lost for many observers in last month's end-of-the-year hullabaloo was the annual Gallup Honesty and Ethics Survey which by a wide margin again ranked nursing as the most honest and ethical profession.
The survey found that 81% of Americans believe that nurses have "very high" or "high" honesty and ethical standards. It marks the 11th straight year—and the 12th time in 13 years—that nursing led all professions in the survey. Gallup says the only time nurses haven't top the list since they were included in 1999 was in 2001 after the 9/11 terror attacks, when firefighters were ranked No. 1.
Not surprisingly, National Nurses United is well aware of the survey results and appears poised to capitalize on that hard-earned public regard.
"We hold that trust as a sacred bond with our patients and our communities," Karen Higgins, RN, co-president of National Nurses United, said in a media release. "Patients and their families expect nurses to fight for them at the bedside, even when it conflicts with the profit motive of far too many hospital managers, insurance companies, and others in the healthcare industry who put the bottom line above patient interest."
"For nurses, that obligation also goes beyond the bedside," Higgins continued, citing the NNU campaign for "sweeping changes to heal our communities and nation, with a program for a Main Street Contract for America premised on jobs with dignity, healthcare for all, a safe environment, and support for public education."
The union is also pushing for a Robin Hood tax on financial transactions to be levied against "Wall Street banks and other financial firms who created the current pain and suffering in our communities…."
NNU has smart, tough leaders and compelling "us-versus-them" and "patient-first" messages that resonate not only with the nurses they hope to organize, but with tens of millions of Americans who play by the rules and still feel like they're getting a raw deal.
The union has gained considerable success and notice since it consolidated the California Nurses Association/National Nurses Organizing Committee, United American Nurses, and Massachusetts Nurses Association in December 2009. The "super union" now boasts more than 150,000 members within a national network and has won most —if not all—of the organizing efforts it has undertaken.
Savvy leadership and a compelling message—while important—are not the only keys to NNU's success. Seasoned and tough leaders can be found in other unions that have not fared as well. In 2010, only 11.9% of the U.S. workforce was unionized, down from 12.3% in 2009. Unions have seen a mostly steady decline in membership since 1954, when about 28% of the workforce was organized, according to the Bureau of Labor Statistics.
Union supporters believe that more U.S. workers would join unions if they could. They don't, the explanation goes, because these workers haven't the leverage to bargain with management, especially in a weak economy plagued by high unemployment.
The frustrations and pressures that nurses encounter on the job can be shared with workers in other sectors from agriculture to retail to heavy industry. Bad bosses, declining wages, and benefits, job instability and lousy hours are not unique to a particular sector.
Nurses, however, know they are in high demand. They know they are not easily replaced. They know their skills—for the most part—cannot be outsourced. Because of all that, they know they don't have to tolerate a dysfunctional workplace. They can vote with their feet and find a new job elsewhere, or they can vote to organize.
NNU's success suggests that when workers are given the chance to organize, usually they will. That annoys a lot of people who want to believe that unions are no longer needed in this era of enlightened management.
Instead, union successes are dismissed as some sort of trickery such as heavy-handed organizing efforts that pressure non-affiliated workers to join. How else to explain the failure of management to contain NNU's organizing efforts, other than to acknowledge the failure of management?
If NNU's only purpose were to increase dues-paying membership, as some critics suggest, that is not necessarily a grand deception on its part, and it does not explain their success. Nor is it explained by the suggestion that unions now hold some momentary advantage thanks to a temporarily pro-labor tilt on the National Labor Relations Board.
The explanation is simple. NNU is succeeding because many nurses—like many workers in many sectors—believe that nobody else in a position of power and influence is looking out for them. The only difference is that nurses are in a position to do something about it.
Many physicians believe healthcare reform won't reduce costs or improve access to care, but it will mean less income and autonomy for them, a new survey finds.
The Deloitte study also finds that only 25% of physicians consider themselves "very informed" on the details of the Patient Protection and Affordable Care Act, while 71% consider themselves "somewhat informed."
Informed or not, Keckley says many physicians developed strong opinions on healthcare reform years ago and those opinions haven't changed.
That dates back into 2009," he says. "They were despondent that the PPACA did not fix the sustainable growth rate, liability wasn't fixed, and the law did very little to get people to live healthier lives. That has been embedded in medicine now for the last two years."
The national survey of 501 primary care and specialty physicians, conducted in July and August, shows that 73% of doctors are glum about the future of medicine and 69% believe the "best and brightest" who are traditionally drawn to medicine will consider other careers
"They are mourning the 'MDiety,'" Keckley says. "The profession seems to be lamenting that the best days of the profession are behind and there is very little blue skies on the horizon. It's understandable but it is surprising."
Only 27% of physicians surveyed believe the PPACA will reduce costs by increasing efficiency, only 33% think it will decrease disparities, and half say access to healthcare will decrease because of hospital closures that result from the law.
The docs are also very downbeat about the impact of healthcare reform on their incomes in the coming year, with 48% believing they will earn less, 48% saying their income will remain unchanged, and only 4% saying they will earn more.
Keckley believes doctors' opinions about the PPACA may be influenced by their reliance on specialty societies for information about the law. "They are listening to someone from their society filter the information that is relative to their specialty and say 'Here is what it means to you,'" he says. "I was not surprised about the low level of understanding, given that there was a resignation that it is a bad thing that's just going to make the problems worse."
Keckley says doctors have become gloomier since the shift away from the fee-for-service model, with the belief that their autonomy and respect for the profession is eroding.
"The two things we found progressively disheartening for doctors are more transparency—that more things about them will be made public. Second is more cuts in the average reimbursement increases that they expect," he says.
Even primary care physicians, who are expected to see increased reimbursements under PPACA, are not necessarily happy about the potential impact on their incomes, Keckley says.
The reason is they still feel it is unfair that they are paid so little when compared with specialists, and they think the law didn't take care of it," he says.
Despite dissatisfaction with their income, physicians remain among the highest-paid professionals in the United States. Keckley cites the Bureau of Labor Statistics 2010 report on median compensation, which lists primary care physicians at $170,000 and specialists at $450,000. That compares with a median of $52,000 to $56,000 for teachers, police officers, and firemen.
So yes, doctors are whining about their incomes because they believe they deserve the highest income that is paid a profession," Keckley says. "They are! But for their purposes it doesn't appear to be as much as it should be. That is a matter of perception.
"Doctors tend to measure themselves against other doctors," he says. "There is a lot of peer influence on what cars they drive, what clubs they belong to. If you look at it objectively, doctors' incomes are pretty good."
Only 35% of physicians gave the nation's healthcare system an A/B grade, and 60% graded it C/D. Keckley says the perceived loss of autonomy has caused physicians to take a generally negative view about the overall quality of the nation's healthcare system.
"Doctors consider a successful healthcare system to be one where there is no limit to accessing doctors, where there are no gatekeepers, and where doctors are not challenged around their clinical autonomy. Period," Keckley says. "The more regulatory oversight in standards of care or evidence-based medicine, and the more you introduce this third-party coverage with insurance, the more troubling that is for doctors. Clinical outcomes are not the basis for how doctors rate the system."
Hospital mergers and acquisitions continued at a robust pace in 2011 as providers used consolidation and market share to elbow out competitors, improve economies of scale, and leverage better prices with vendors and insurers.
The top 10 hospital mergers and acquisitions in 2011 were valued at $5.6 billion, up from $3.8 billion in 2010, according to Sanford Steever, editor of The Health Care M&A Information Source, published by Norwalk, CT-based Irving Levin Associates. Hospital M&A carried a total value of about $7.3 billion in 2011.
In all of healthcare, including hospitals, drug and device makers, distributors, and health insurance companies, mergers and acquisitions were valued at about $236 billion in 2011, one of the busiest years in a decade, and up from $206 billion in 2010, Steever says.
"Activity is up over the previous year, although there haven't been any huge portfolio deals," Steever told HealthLeaders Media. "There has been a lot of activity in the middle market."
The year's two biggest hospital deals—each valued at more than $1.4 billion—include Highmark's acquisition of the five-hospital West Penn Allegheny Health System, and HCA's purchase from the Colorado Health Foundation of its 40% interest in the seven-hospital HealthONE system.
Most of the structural factors that drove M&As in 2010 were still in play this year. "The healthcare delivery system…remains fragmented. Hospitals will combine to create economies of scale, perhaps create some synergies by combining operations, and increase their patient base," Steever says. "The countervailing force is that the delivery of healthcare is local. So, you want to focus on the local but provide as broad a network as you can. If you're a member of a multi-hospital system, you probably have a better bond rating and more clout with vendors and insurers."
Steever says the passage of the Patient Protection and Affordable Care Act continues to play a big role in accelerating hospital M&As. "Before the Affordable Care Act was passed, the rate of hospital deals was very low because people didn't know what the outcome was going to be and they didn't know what the reimbursement protocol was going to be," he says. "Because of that they couldn't accurately calculate revenue and cash flow, and that made it hard to place valuations on businesses they wanted to buy."
"Once ACA passed activity took off, although a lot of it is vertical. You have hospitals buying physician groups and IT businesses to put together the elements of an affordable care organization," he says.
Steever says he expects that hospital M&As will continue at a healthy clip in 2012. "The only thing that could slow it down is dithering over the election and the direction that healthcare might take depending upon who wins the White House," he says.
"If healthcare becomes a big issue in the campaign, it will slow down the deal-making," he says. "The partners will take longer in their due diligence because they will want try to accurately value the deal, so they will have to compare a scenario where the Affordable Care Act continues to kick in versus one where it gets stripped out. They will have to produce valuations that take both scenarios into account. That just slows down deal-making but it is not going to stop it, because the underlying structural reasons exist regardless of what happens with the government."
Steever does not believe that access to capital will be a problem for the larger, stronger providers that are in a position to gobble up smaller competitors. "The capital is there and it is going to be there for those hospitals because they are fairly large. The smaller entities are still going to experience difficulty accessing capital," he says.
"Private companies are sitting on a huge wad of cash. There are some publicly traded companies have great cash flow, and some of the Catholic not-for-profits have great bond ratings and great tradition of fiscal responsibility and uncanny management," he says. "Access to capital is not a brake on this activity."
In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. All of them are playing a crucial role in making the healthcare industry better. This is the story of Wright L. Lassiter III.
This profile was published in the December, 2011 issue of HealthLeaders magazine.
"Organizations like ours are large and complex and if you are going to drive accountability in your organization, then everybody has to play a part in solving problems."
In September, Alameda County Medical Center was recognized as a Top Performer in Key Quality Measures by The Joint Commission, which placed the safety-net health system among the top 14% of 3,099 accredited hospitals in the United States.
That distinction marked the latest affirmation of a remarkable turnaround for the Oakland, CA–based six-facility public system, which only six years earlier had been near collapse. That turnaround trajectory started in 2005—and not coincidentally—with the arrival of Wright L. Lassiter III as CEO.
In the year before his arrival at age 41, the federal government had threatened to pull the health system's accreditation for a number of jaw-dropping infractions, the most notorious of which was the strangulation death of a physician by a patient at ACMC's John George Psychiatric Pavilion. A few months before Lassiter took the job another patient at the pavilion had hanged herself in a doorway.
"I had some reservations about pursuing the job as I began to understand what some of the issues were. I had some natural trepidation about 'Is this something that is a wise career move?'" says Lassiter, who chose ACMC over the relative security of his executive post at JPS Health Network in Dallas. "I had a combination of private hospital experience with a public hospital inclination. This specific set of skills is very important."
"When I came out here my hope was that I could engineer the type of turnaround that would create a sustainable path for the organization," he says. "It wasn't just about money and quality indicators. It was about driving a different kind of culture. That stuff doesn't take a short period of time."
It wouldn't be accurate to say that there was a crisis in leadership at ACMC before Lassiter arrived, because there was no leadership. ACMC had chewed up and spat out 10 CEOs in the 10 years before him.
"What I inherited was the view that the CEO was a turnstile and a place of instability," he says. "Because the CEO role rotated so much, there was a fair amount of churn in the senior leadership and there was instability in leadership and direction."
ACMC's finances were a disaster. The health system's balance sheets were hemorrhaging red ink. ACMC owed the county about $200 million, with no immediate prospects for repayment. The mostly unionized staff was mired in a status quo culture of frustration, suspicion, and apathy.
Even with that uncertainty, Lassiter took the job because he was assured by the system's newly appointed board that it would support a change in culture. The public had also demonstrated its support for the mission before his arrival when it approve a sales tax hike that would generate about $75 million annually for the health system.
With the system's financial problems apparently stabilized, Lassiter says he planned to spend his first few weeks at ACMC "learning and listening to understand what the key priorities were, and then deciding where to go." That listening tour was scotched within the first week, however, "when I arrived and the first set of financials I saw showed that the organization was losing about $1 million a month," he says. "That was not something that was projected in the budget and it was something the board had not been made aware of. I had to plug a hole in a ship that was leaking oil badly. That was first priority."
With challenges come opportunities. Rather than wielding a budget cleaver and chopping staff, Lassiter hired a like-minded C-suite team that engaged staff to find savings across the organization and that would result in fewer job eliminations.
"We used a team approach to garner revenues, enhance cost savings, and find contract savings," he says. "We also had a (Centers for Medicare & Medicaid Services) survey of our psychiatric facility that happened six days on the job that wasn't particularly flattering.
It was the first time in my career that I had had a survey go that badly. I used that as a rallying cry for the organization and I challenged the organization. 'Do we believe we should go from survey to survey riding correction plans, or are we going to focus on creating discipline to demonstrate that we are better all the time?'"
While the first months on the job proved stressful, Lassiter says they also demonstrated his commitment to the mission, and his willingness to listen.
"I thought it was important early in my career—and still to some extent now after a number of years—to make sure that the organization understands that the problems can't get solved in just the CEO's office, the proverbial ivory tower," he says. "Organizations like ours are large and complex and if you are going to drive accountability in your organization, then everybody has to play a part in solving problems."
Now, after six years, ACMC still faces challenges, including the prospect of lower Medicare and Medicaid payments. However, Lassiter believes ACMC has turned a corner. In addition to The Joint Commission recognition of improved quality, ACMC has also eliminated its leadership turnstile, and is operating—mostly—in the black. The system now looks to generate between $3 million and $5 million in net income each year, has whittled down its debt to the county to about $140 million, and plans to repay the debt by 2018.
From his office window, Lassiter can monitor construction of ACMC's $670 million expansion. When he walks the hallways he encounters dedicated professional staff providing quality care, often to the most vulnerable people in our society.
The son of an ordained minister, Lassiter says he gains spiritual fulfillment from the success of ACMC. "You get great satisfaction creating a high reliability, high quality, high patient experience organization and one that treats the people who don't have lots of options," he says. "So, to take care of this population is one of those things that gets me up in the morning."
This article appears in the December 2011 issue of HealthLeaders magazine.
In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. All of them are playing a crucial role in making the healthcare industry better. This is the story of Min-Shin Chen.
This profile was published in the December, 2011 issue of HealthLeaders magazine.
"The way I look at it is not what could have been, but this is our new life."
A "good day" for family caregiver Min-Shih Chen is often measured by what doesn't happen for his wife Gloria, 71, who is battling Parkinson's disease.
"A good day for her is there are no incidents. She is cared for. She is content. There are no expected illnesses or difficulties," says Chen, 68, of his wife of 42 years. "It's a good day when I can take sufficient care of her. If my wife has a good day, then that makes me happy."
Chen is one of the estimated 65 million Americans—roughly 29% of the population—who provide a total of $375 billion in uncompensated healthcare each year for a family member. That is more than double the $158 billion that is spent on homecare and nursing home services, according to estimates from the National Alliance for Caregiving and AARP.
Gloria Chen was diagnosed with Parkinson's in 2004, and since then it's been a tactical retreat against the relentless degenerative disease. When Gloria, a retired music therapist, was still able to walk, Chen took her to a physical therapist and watched the treatments, using what he learned to help his wife. He devised a set of portable parallel bars in their Ann Arbor, MI, home to help her exercise.
"Since last year she has lost more and more of her mobility. Before that, I had transformed my home more like a physical therapy gym. We did a lot more physical therapy twice a day, to keep her mobility as long as possible. But eventually it was lost," Chen says. "I can no longer do walking with her."
The Chens' life now revolves around four daily "cycles" starting around 8 a.m. and ending around 8 p.m. Each cycle lasts about three hours, and involves bathing, feeding, administering medications, rest, and moving Gloria—who has been rendered nearly speechless as the disease progresses—from her bed to her wheelchair, from her wheelchair to her recliner, and back again.
"She can no longer eat solid food, so I give her a nutritional supplement. She has trouble drinking through the straw so I let her drink as much as she can and then I spoon feed her the rest. Then I transfer her from her wheelchair to her recliner. So, she rests and then I work around the household," says Chen, who retired from his job as an IT professional three years ago to care for his wife full-time. "I get her up and bring her to the dining room table because I really want her to feel her life as normally as possible. On the dining room table I give her medication, and this repeats four times a day. Also, I take the opportunity when she is more mobile at the time, we do physical therapy exercises."
Chen usually gets a couple of hours in between the four cycles during the day when his wife is napping. He keeps up with household work and doing home modifications to adapt to her abilities. For himself, "I do exercises, and I have a garden. I am doing fine," says Chen.
Shifting Gloria from her bed to her wheelchair and the recliner are often the most challenging part of the day, Chen says, because they both weigh about 130 pounds. "I learned techniques from when she was in rehab and also learned some techniques from the physical therapist," he says. "Now because she has lost so much ability, I have to use a lift to get her to bed."
Chen says it could be worse. He says they are fortunate because they have Medicare, good retirement benefits, and secondary insurance through a commercial provider, and he doesn't have to leave her alone to go to work. "We still have to pay a fair amount of out-of-pocket expenses for copay and her supplies. But we planned our retirement for the worst-case scenario, so financially I am okay," he says. "I also know many caregivers are in real financial hardship."
When time allows, he is also a frequent contributor to a website established by the National Family Caregivers Association. "I started joining the network trying to just exchange ideas on how to take care of our loved ones. But then I found that the emotional aspect of supporting other caregivers is probably more common than just sharing ideas about how to take care of loved ones," he says. "And it is my social outlet, my outside contact. Sometimes we have new people join and the first thing they realize is 'Oh, I am not alone.'"
In the three years since he became a full-time caregiver for his wife, Chen has learned to adjust. Providing care for a love one requires a change in priorities and expectations, and he refuses to get depressed. "The way I look at it is not what could have been, but this is our new life. So, I no longer compare us with how other people live or how we used to live," he says. "I just think about how we can get the most out of the circumstances, and treasure whatever quality of life we still have left."
This article appears in the December 2011 issue of HealthLeaders magazine.
