 CEO Mark Judy tells us how his hospital is adjusting to the changing world around it.
Population and demographic changes are at work around the country. Snohomish County, Wash., the home of Valley General Hospital, is one example. According to CEO Mark Judy, rapid population change in the hospital’s backyard is one of the biggest challenges facing VGH.
 Mark Judy, CEO
One issue confronting Judy’s team involves right-sizing the medical staff. Snohomish has seen its population increase more than 40% over the last two decades, including a 158% increase in the non-Caucasian population between 1990 and 2000. With the population exploding around it, VGH experienced patient increases across the board, as well as an increasing need to address the diversity issue. With these changes also came the need for more doctors, and since physicians are a highly sought after commodity, VGH needed to make itself attractive.
“Hospitals use a variety of methods, from direct employment to recruitment assistance and income guarantees to identify the expansion of the medical staff,” said Judy, who serves on a number of boards, including chairing a community diversity council, and participating with the Washington State Hospital Association as the current chair of the board of trustees. “Even though we’re small, we need to have the same quality standards as the big Seattle hospitals.”
And it isn’t just the doctors. Like others in the healthcare field, VGH is tackling the national nursing shortage, serving as a training site for a local community college as well as a University of Washington campus. It also established what types of nurses are likely to be attracted to VGH.
“We cannot compete for individuals who want to move up the clinical ladder of specialized nursing, because that’s not who we are,” Judy said. “We tend to be a magnet for nurses that have established themselves and want a breadth of nursing experience.”
Judy believes physician and board-member interaction have established a unique working relationship that helped with recruitment issues. Active participation of doctors in the planning process was essential in determining the proper numbers and specialties that VGH will need over the next 10 to 15 years, he said.
As part of this long-term plan, the hospital added physicians in general surgery, orthopedics and internal medicine. When one of its primary care groups ran into financial troubles, it stepped in to right the ship, selling the practice back to the group after an 18-month intervention. And since VGH has a small core of physicians, it has been able to monitor quality indicators more easily than a larger facility.
“Our medical community tends to be younger, forward thinking. They want to work with the hospital to bring about change,” Judy said. “This provides a superb arena for dealing with issues between physicians and the hospital over a sustained period.”
Reform parties
VGH is currently dealing with several forces of change affecting its industry along with its community. Healthcare reform is a hot topic, especially in an election cycle. In fact, VGH and area hospitals already faced one round of reform that directly affected its primary care base. In the mid-1990s, Washington state put through a significant healthcare reform package. Although several factors contributed to its ultimate reversal, a number of PCP practices sold themselves into larger networks in anticipation of reform. Because of this, nearly 70% of VGH’s primary care base is now owned by one of its larger competitors.
“There’s a risk of having referrals to our hospital altered for business reasons beyond our control, so we always have that in the back of our minds,” said Judy. “But it is a mixed blessing, as we are not in the position of having to subsidize the primary care in our community like many hospitals.”
As VGH has grown with its community, the demographic changes brought about an increase in ED traffic and charity care. Instead of attempting to stifle that growth, VGH adjusted. It brought in a medical director from a California emergency department who put the hospital on a path to improve its ED product. By systematically addressing everything from the admission process to increasing nurses’ authority, Judy feels VGH is doing what it can to accommodate this transition.
“We’ve been working to ensure we’re achieving as rapid a response time as possible,” said Judy, adding that VGH replaced all of its imaging equipment over the last two years. “We’ve differentiated true emergency patients from walk-in clientele, and we have a facility adjacent to our emergency department used as a fast-track clinic during busy times of the day.”
Judy also said the hospital invested in a $5 million IT upgrade including a PACS, a radiology information system, and an electronic medical records system that will be completed in about two years. “It’s not just a momentary reaction to try and facilitate change in that area. It’s a long term commitment the board made last year.”
But the hospital has already proven its commitment to the community through its behavioral health programs. According to Judy, VGH’s chemical dependency and senior behavioral health programs are an historical asset. In the next year, VGH plans to double the size of the chemical program from 20 to 40 beds and has recently added two beds for the senior program. “These programs are doing remarkable work dealing with the combination of behavioral, psychiatric, emotional and acute medical care problems these groups face,” Judy said.
And although the demand for these services is high, VGH has limited program expansion for now. This is partially due to facility restrictions, as well as the significant capital VGH would need to raise. But the chemical dependency program is being relocated into a former assisted living facility. And as a municipal hospital whose primary method of capital expansions comes from public voted bonds, VGH is already planning on a major capital program in 2009 to replace its acute care clinical service, something Judy feels is a key part of its future.
“Our current medical and surgical facilities date to the early 1970s. Our patient rooms are small and don’t accommodate the delivery of medical care that’s expected today,” said Judy. “That is one major effort we need to tackle.”
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