FUTURE TAKES SHAPE: Hospital leaders target key areas — emergency care, quality and potential for new patient tower

July 22--As a strategic plan is formulated at Wilson Medical Center, the hospital's chief executive officer gave a look at what it would contain, including the possibility of a new patient tower for either women or children or something more global in nature.

Officials are also taking a look at the Emergency Department and how to move patients through more efficiently while mental or behavioral health will get a close look overall at the hospital.

CEO William Caldwell has a new leadership team taking shape, including Chief Operating Officer Bert Beard and Chief Nursing Officer Laura Lowe.

STRATEGIC PLAN

Hospital officials are in the assessment phase of the strategic plan.

"We have to figure out the facilities," Caldwell said. "We are celebrating our 50th anniversary this year, and parts of that building are 50 years old. There will be a facilities plan."

The hospital has a major project that received a Certificate of Need from the state previously in a new women's and children's tower. But that project continually got pushed to the back burner after the economy slipped into a downturn.

It's getting a fresh look now and may move into the forefront.

"We have to figure out will we be building a new patient tower or will we rework the existing patient tower," Caldwell said.

There is a lot of desire both locally and at LifePoint to move forward on the women's and children's project.

"We have to fit it within the context of the decision on the new tower," Caldwell said.

The hospital had almost 1,000 births last year -- 963 to be exact.

The women and children's patient tower could morph into a global patient tower.

There are existing drawings on file at the hospital. Most of those locate the tower in front of the existing facility.

But they aren't constrained by that, Caldwell said.

"We have engaged architects and engineers with LifePoint to look at the old plans to see what makes sense," Caldwell said. "We are not landlocked. That gives us options."

EMERGENCY DEPARTMENT

The emergency department is an important piece of the overall strategic plan.

"One of the things that's a perception in the community is sometimes you wait too long when you come to the emergency room," Caldwell said. "Every emergency room out there, no matter where you are, or how well run you are, you are going to have patients waiting. It's unavoidable. The goal is to minimize that."

Sometimes it may be getting a person admitted, and they are being held in the emergency department and it has a ripple effect.

"We are working hard in the ED to improve our turnaround time ... because it really is the front door for the hospital," Caldwell said.

In Wilson and beyond, the majority of admissions come through the emergency department.

In fact, there are nearly 47,000 ER visits a year and nearly 31,000 inpatient days a year for the facility overall, excluding newborns.

"There are some basic process things we can do to help," Caldwell said.

An example is if they have an open bed, they can just bring the patient right to the bed and register them at the bed, Lowe said.

"Eliminate steps in a process," Caldwell added.

Wait times won't be the only area they look at.

They want to make sure they have adequate coverage of various specialties.

'GOOD SHAPE'

Caldwell sees the challenges as less on the mechanical side.

Overall the equipment side of the hospital is in "pretty good shape," Caldwell said. "There are needs, but overall the equipment is in good shape."

"Building challenges are things like square footage in a patient room," Caldwell said. "Our rooms are small, some don't have individual showers, things if you are building a room today they would be larger ... The good news is we have the square footage. We have the square footage to a make an equation work if the decision is to do it in the existing structure."

Two newer rooms would equal three older ones.

Caldwell is really impressed with facilities such as radiation/oncology and the wound healing center.

"Physical changes will come; they take time," Beard said. "Patient experience and quality of care is a priority across the board."

Clinical quality "we can work on today and we are," Caldwell said.

QUALITY

Quality care will differentiate Wilson Medical Center in the future, Caldwell said.

"The Duke quality people have been on the ground here," Caldwell said. "We've done a little bit of internal restructuring."

Organizationally, the quality manager and staff are just doing patient quality, he said.

"We created a quality safety officer position that reports to the CEO."

Some efforts will be felt immediately. Some things will take longer.

Patient experience and how patients perceive the hospital and the care they receive is important, officials said.

"We are going to be in the top 5 to 10 percent of hospitals nationwide," Caldwell said. "If that raises the bar for all our competitors, great. You know what happens then, the community benefits. The outcomes are better across the board. We'll go from good to great. It won't happen overnight, but I think you'll see it trend over time."

Hospitals will even be paid in the future, in part, based on quality and patient outcomes.

It's part of the Affordable Care Act where reimbursement programs such as Medicare include bonuses and penalties based on certain quality measurements.

These reforms have far-reaching implications for medical-care providers and patients alike -- all of whom are trying to navigate their way through this tumultuous, unprecedented time of health care change.

Duke LifePoint HealthCare officials also noted they and others in health care will be paid in the future on a basis of quality and outcomes. The idea is you have to deliver the best possible quality and outcome, and you have to deliver it at the most efficient price, officials said.

Patient safety and quality factored into the proposed agreement ultimately approved between Wilson Medical Center and Duke LifePoint.

National health care reform and cuts in reimbursements prompted Wilson Medical Center's move to sell a majority stake, 80 percent, to Duke LifePoint HealthCare with the formation of a joint venture.

The proposed agreement requires the establishment of a Patient Safety and Clinical Quality Committee and, subsequently, a comprehensive quality plan. It starts with a baseline plan the first year, and then it's measured against "reasonable and incremental quality metrics."

In the event the hospital fails to meet the targets or metrics for any two quarters during the second year of the agreement or any year thereafter, a quality improvement plan will be prepared.

"If the hospital fails to meet the requirements of the quality improvement plan for any two quarters during a year and the metrics the hospital has failed to meet are no greater than those of any hospital owned by Duke University Health System, Duke LifePoint has the right to sell to a LifePoint network subsidiary or an affiliate or subsidiary thereof Duke LifePoint's equity interest in the company," the agreement states.

Officials previously said the Duke provision, while highly unlikely to be exercised, is there to exert pressure on the joint venture to drive quality, which is a focus of Duke.

Quality performance reports are available online for every hospital in North Carolina at www.NCHospitalQuality.org. There are numerous reports including a quality dashboard.

The N.C. Center for Hospital Quality and Patient Safety developed the hospital-specific performance report for the state. It is updated quarterly with data from Centers for Medicare & Medicaid Services and the Carolinas Center for Medical Excellence.

MENTAL HEALTH

Mental health treatment is a challenge for every community and state.

The hospital moved away from inpatient services years ago. But new leadership is giving this issue a close look.

"There is less of a stigma attached to seeking help," Caldwell said.

And simply put, more people are willing to do so, Lowe added.

The growing substance abuse issue in the U.S. is just one indicator.

"The United States consumes 80 percent of the world's narcotics," Beard said. "You have a segment of the population recovering."

The hospital has the space and will carefully evaluate it, Caldwell said.

"There is no question the need is there," Caldwell said. "I think the biggest challenge is finding a psychiatrist."

Hospital officials also know if they ignore it, behavioral health could manifest itself in the emergency room.

"You can't wash your hands of it; you can't ignore it," Beard said.

There is a space in the emergency room just for behavioral health, and it's generally pretty full, they said.

There's a challenge "to find a place for definitive care within this community," Lowe said. "There is no place to send them."

CHIEF NURSING OFFICER

Laura Lowe began work May 19 as chief nursing officer or CNO. She oversees all nursing services and has responsibility over nursing practice there.

"If they are practicing in our facility, whether they have independent licenses, I have responsibility," Lowe said.

It's a great responsibility as about 300 nurses practice in the hospital.

Lowe said the ultimate goal is to have all permanent nursing staff, and they've worked to reduce the number of contracted or traveling nurses.

They are currently supplementing with contracted staff in order to take care of patients, Lowe said.

"Most of the time you have better commitment when you have someone from their community working in their community, but we would hold the same standards for anyone working here," Lowe said.

It's also more costly to have contracted services. The nurse works for a company, and the company is paid.

"We are trying to build up our nursing staff to recruit to Wilson," Lowe said. "It can be challenging. A lot of younger nurses coming out want to go to the big city. We are very fortunate to have Barton and the community college."

There's a national nursing shortage that's expected to get worse as the population ages.

In addition, there are waiting lists to get into community college programs and college programs face faculty shortages in some communities.

It's a cycle that continues to make nursing a highly coveted profession.

"Even on the physician side and beyond," Beard said of medical schools, "there is an infrastructure pipeline issue."

Wilson Medical Center has cut its reliance on contract nurses, they said.

"At one time we were up to 50-some contract nurses," Caldwell said. "We have cut that significantly."

Lowe's goal is making sure nurses provide excellent care and it's a place nurses want to work.

Lowe most recently worked at the Mayo Clinic Health System in Mankato, Minn., where she served for nearly six years in several roles, including director of patient care and inpatient nursing and vice president of regional nursing and operations.

Lowe was also director of emergency and trauma services at St. John's Regional Medical Center in Missouri and manager of patient care in emergency medical services in Boone Hospital Center in Missouri. Her experience includes 11 years as a flight nurse and in intensive care, critical care and cardiovascular care, hospital officials added.

Lowe is completing a Doctor of Nursing Practice degree from Rocky Mountain University of Health Professions in Provo, Utah. She holds a master's in Health Care Administration from the University of Missouri in Columbia, Missouri, and a bachelor of science in nursing from Excelsior College in Albany, New York.

CHIEF OPERATING OFFICER

Bert Beard, chief operating officer, oversees several areas and can run the day-to-day operations to allow the CEO to focus on bigger picture areas, regional growth and the community.

"We all work closely together," Beard said. "No one ever says it's not my job, My first mentor told me this: 'I see my job as getting people who are taking care of our patients what they need to do their job.' I take care of them."

Beard's goal is to empower directors to own their business, he said.

Beard's father was in health administration for 30 years. It's something he always knew he wanted to do.

"Every day is different," Beard said.

Beard is impressed with the culture of Wilson and investment folks have with their hospital and community.

Beard, who has served as associate administrator at Manatee Memorial Hospital, a 319-bed acute care facility in Bradenton, Florida, began work

in Wilson on April 21.

The COO position is a new one for the hospital.

Beard has also served as associate administrator/assistant chief staffing officer and interim COO/chief staffing officer at Summit Medical Center, a 188-bed facility in Hermitage, Tennessee, affiliated with Hospital Corp. of America in Nashville, Tennessee. He also served as administrative resident with TriStar Health System, a 14-hospital system based in Brentwood, Tennessee, and also affiliated with HCA.

Beard has master's of health and business administration degrees from Georgia State University in Atlanta and a bachelor of arts in business administration from Furman University, officials said.

OTHER AREAS

The hospital will also focus on physician recruitment, particularly where there are needs in specialities such as rheumatically.

Caldwell said overall they are in good shape, and he's been impressed, but there are some areas in which they want to focus.

The hospital remains a busy facility. There are about 3,400 outpatient surgeries and 900 inpatient surgeries each year.

Caldwell was named the chief executive officer in late March. He's been assembling his team, learning the ins and outs of the facility and meeting community members.

Caldwell previously served as chief operating officer of LewisGale Medical Center, a 506-bed tertiary hospital and regional referral center in Salem, Virginia. Prior to his role as COO, Caldwell served as vice president for physician practice management for LewisGale, overseeing the operations of more than 130 provider practices, including a multi-specialty clinic. Previously, he served in various executive roles for Henrico Doctors' Hospital and Retreat Hospital in Richmond, Virginia, and John Randolph Medical Center in Hopewell, Virginia.

Caldwell holds a Master of Health Administration degree from The Ohio State University in Columbus and a bachelor of business administration from the University of Notre Dame.

Duke LifePoint acquired the 80-percent stake of the hospital this year in a $56 million joint venture deal with Wilson Medical Center.

Duke University Health System calls Durham home. LifePoint Hospitals is headquartered in Brentwood. LifePoint is the managing partner.

Wilson Medical Center, which has more than 1,300 employees, has emerged as the third-largest private employer in Wilson County. The hospital has 294 beds.

"Typically health care employees feel bad if they toot their own horns," Lowe said. "They consider it their job to provide excellent care. We are a business, and we want to tell people the great job we do because there are options for patients and they need to hold our feet to the fire to meet those quality outcomes and we will and it will show up on reports."

[email protected] -- 265-7813

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