Things in General
By CINDY SANDERS
A Conversation with Nashville General CEO Joseph Webb
Nashville General Hospital at Meharry has served the city for more than 125 years. Touted as Nashville's original community-based hospital, the facility first opened its doors in April 1890 as City Hospital on Hermitage Avenue.
Now located on Albion Street, much of the hospital's recent history has focused on its financial instability and questions about how ... and if ... it still fits into Nashville's healthcare landscape. With new leadership in place and the Joint Commission's Gold Seal of Approval®, there are growing signs Nashville General has turned the page and started a new chapter in its story.
When Joseph Webb, DSc, MSHA, FACHE arrived in Nashville to take the reins as CEO of Nashville General on Jan. 5, 2015, the seasoned healthcare executive had to address issues across the operational spectrum. Webb said the first order of business was to complete an assessment to determine gaps. "The first thing you have to do is look at what resources are available to you to provide a safe environment for the patient population you are going to be serving," he said. "At the end of the day, that's what it's all about."
After years of interim leadership and public speculation about the hospital's future, one of the initial tasks was to address staffing. "The organization did face a good bit of out migration because of the uncertainty," Webb said. Asked if naming a permanent CEO provided reassurance, he replied, "I think it certainly did. That was the first step towards the city showing the commitment to continuing to operate (Nashville General) as a hospital."
Hand-in-hand with staffing issues were quality concerns. "There had been some issues being investigated by the Joint Commission for Hospital Accreditation," Webb noted. "In addition to that, the window was imminently opening for the full survey, which occurs every three years." He continued, "We began to work expeditiously to look at the gaps in clinical services we knew would be under the microscope of the Joint Commission. What we needed to do was to shore up any areas that were lacking."
With historical issues and lapses in documentation that would be apparent when the Joint Commission team traced back through charts, Webb said the focus had to be on ensuring those problems wouldn't occur again in the future. "Your strategy has to be that you are overwhelmingly confident that you have put in place structures and processes that will change the way those thing are done," Webb said.
However, it also takes money. After the survey last fall turned up deficiencies in infection control, staffing, and safety, the Metro Council agreed to approve additional funding earlier this year to allow the hospital to address both the concerns identified by the Joint Commission and some barriers to ongoing sustainability.
This summer, a Joint Commission team revisited the hospital to drill down in the areas that had been previously flagged. "They were here for three days," said Webb. "What they found was nothing that would have prevented them from giving us full accreditation, which is excellent. You can't ask for anything better than that," he continued.
"In healthcare, the main thing you want to convey to the public is we are a provider of safe, quality care," Webb said. "When the Joint Commission says you have the gold seal of approval that comes from accreditation, you can make that statement."
Although the hospital has now cleared that hurdle, Webb recognizes there is much more work to be done to reposition Nashville General to attract a broader audience, including more commercial pay and Medicare patients, to move toward greater financial stability. Currently, he said about 40 percent of patients are self-pay or indigent.
"The role we feel that we can play here ... the niche that is available to us ... is to be a small community hospital that provides excellent care to its customers. Not everyone wants to drive the large SUV. Some people like to drive the small, economic vehicle," he noted, adding a smaller hospital conveys more of a boutique feel. "If you want high quality care in the setting we offer, which is smaller than you would see at other hospitals in the city, then we are here for you. What we have to do is make sure the people who want to come here have a good experience."
While diligently working to attract new patients, Webb said it is equally important to continue serving those without the financial means to pay. "What this hospital does is to promote the identity of a specific location where you can go and are not likely to be turned away because of your inability to pay ... and that speaks to access to healthcare services." Webb added he believes Nashville's leadership recognizes and appreciates the importance of this role.
In total, Nashville General received a $45 million subsidy from Metro for fiscal year 2016. Webb said new policies have been instituted internally to improve stewardship of those funds. "The major cost of operating a hospital is your labor cost. We've built and implemented a productivity system," he said. "Each leader is responsible for staffing their area according to their critical metrics. We're holding our leadership accountable for it, too. That really wasn't done before."
Webb added supply costs and operational inefficiencies are also being addressed. "We put in place some LEAN-trained individuals to work with directors to make sure where there are opportunities to eliminate waste in the system, they are able to do that."
Webb continued, "When you are trying to improve your financial sustainability, you look at your key cost factors and also how you grow your revenues."
Focusing on the second part of that equation, Nashville General recently opened the outpatient Nashville Healthcare Center, which is a patient-centered medical home, to provide continuity of care from the outpatient to the inpatient setting. A new outpatient pharmacy has also recently opened in close proximity to the clinic. On the inpatient side, Webb said there is a newly renovated and upgraded Labor and Delivery unit.
Having a strong non-profit foundation, Webb noted, is another key component in establishing resources to care for indigent populations. The Nashville General Hospital Foundation (formerly Friends in General) now has a full-time executive director and full board of directors.
"Nashville General is on track to be a hospital of choice," Webb concluded. "We want the value proposition to be that Nashville General is excellent not only for the city but also for the private sector."