Delaware Valley Hospital: Just Right
Hospitals
Written by Mike Sharkey   
Monday, 01 October 2007
Delaware Valley Hospital: Just Right - Health Executive - RedCoat Publishing
By responding to ever-changing community needs and focusing on quality, this rural New York hospital overcame a gauntlet of obstacles.
At Delaware Valley Hospital in Walton, New York, a picturesque community of 5,500 located at the base of the Catskill Mountains, the term “right sizing” takes on new meaning.

Delaware Valley Hospital: Just Right - Health Executive - RedCoat Publishing
David Polge, CEO
For some in healthcare, it’s a PR friendly way to say downsizing—another word for layoffs. But at rural, 25-bed DVH, right sizing can be taken quite literally. It means directing scarce resources to the areas they’re needed the most, sometimes adding programs and services, other times retracting them depending on local population trends, state and federal regulations, and shifts in reimbursement.

It’s a high-wire balancing act DVH has become adept at in CEO David Polge’s 17 years at the helm, enabling the hospital to thrive in a turbulent environment.

For the responsible stewardship of its resources, DVH has been rewarded. The hospital was designated a critical access hospital by CMS in 2005, and over the past two years, it has received grants from the state to help implement health IT systems and build a new emergency department and imaging center.

Said Polge, “We’re proud that we’ve responsibly led our hospital through quite the maze of challenges and issues in rural New York State healthcare. Now we can prepare the facility for the next 50 years.”

Being flexible
The future wasn’t so bright when Polge first arrived in Walton. In 1990, Delaware Valley Hospital was struggling to keep its doors open and hadn’t seen a positive bottom line in eight years.

As a first step toward a turnaround, Polge opened the channels of communication. He made the organization’s financial predicament clear to all 230 employees and asked for their support. Employees gave it in the form of an agreement to reduce their work hours, lowering payroll and giving DVH some much needed savings.

Polge also took advantage of economies of scale. Just before he became CEO, DVH had become affiliated with United Health Services. As a member of the four-hospital system, DVH was able to renegotiate contracts to generate further savings. After tightening the belt, Polge and his team began looking for opportunities to generate new revenue.

Based on community need, DVH hired an OB specialist and opened an obstetrics program. Soon after, a mobile CT scanner, and all the diagnostic services it offers, was added, and the hospital created an addiction treatment program. “These programs met a need and generated new revenue for us,” Polge said. “They were a perfect fit.”

Within three years, DVH was back in black after more than 11 years in the red, but changing conditions soon called for additional right sizing. A growing national nursing shortage crisis made it impossible for DVH to staff its ICU at Institute of Medicine standards. As a result, the hospital closed its ICU. And when DVH’s relatively new OB program slowed significantly in 1997, the service was cut and resources were redirected to serve the community’s increasingly senior population.

The hospital’s proactive stance allowed it to remain in the black and avoid a financial relapse. When the State of New York’s dreaded Commission on Healthcare Facilities for the 21st Century (the so called Rightsizing Commission) came calling in 2005, Delaware Valley Hospital was lauded for being appropriately sized and staffed to meet the needs of its community.

“In all our years of looking at community need and focusing our services and resources, we right-sized ourselves a number of times,” Polge said. “It was gratifying to know we did that on our own and didn’t have to have the commission do it for us.”

Quality focus
The companion piece to Delaware Valley Hospital’s financial turnaround was a dramatic culture change that put the focus on teamwork, quality, and continuous improvement.

When Polge first became CEO, the hospital was cited for a number of deficiencies by the Department of Health and given an order: track and document the quality of care at DVH. By clearly communicating to all employees the
serious issues the hospital had to address and expecting individual responsibility and accountability, Polge got the entire organization behind a quality improvement effort.

Open communication became a staple of the quality initiative. Hospital leadership coached managers to become attuned to front-line employee needs; regular employee forums were created; and weekly Take Five sessions allowed managers to meet with staff members to outline goals, detail progress, and recognize achievement. DVH also began taking part in United Health Services’ campaign for excellence, which focused on improving patient and employee satisfaction.

“Employee satisfaction, patient satisfaction, and quality go hand in hand,” Polge said. “Happy employees work hard on fulfilling the mission and vision and provide great care. That leads to improved quality and patient satisfaction.”

The organization’s improvement efforts yielded significant returns: DVH met all of the Department of Health’s orders for quality improvement; scored 27% higher than the national average for employee satisfaction, according to John Baird & Associates; consistently ranked in Press Ganey’s top 10th percentile for inpatient satisfaction, and the top first percentile for ED satisfaction and was recognized by CMS’s New York quality improvement organization as a best practice hospital for cardiac and pulmonary care.

“Working together, we’ve achieved so much,” Polge said. “It’s something to be extremely proud of. I’m the CEO and leader, but you don’t have success like this without a great team of senior managers, department managers, and committed staff. We’ve overcome challenges, grown tremendously, and now we can prepare for the future.”
 
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