Another area of opportunity might be materials management and purchasing strategies that may allow for economies of scale the hospital couldn't achieve on its own.
"Virtua is working on how we might share our expertise in Six Sigma and Lean with other hospitals that may want to remain independent and at the same time could generate some revenue," says Miller. "There are real positives in this idea, especially for hospitals that are doing well. That will allow them to make decisions later on whether to join the health system."
For his part, Medaglia feels the independent strategy is right for Saint Anthony, but it might not be for others.
"One of the positive sides of being part of a system is you get to become part of quality initiatives and other clinical and nonclinical programs. When you become independent, you have to do that on your own and be very disciplined about it. So it's not for everyone."
Philip Betbeze is senior leadership editor with HealthLeaders Media. He can be reached at firstname.lastname@example.org.
1. Don't fight the big boys: You simply can't offer the wide array of services that the big-city academic medical centers do. So don't compare yourself to them, and certainly don't fight them for patients. Instead, your advantage lies in service and an ear for community needs. Build on that. Guy Medaglia, CEO of Saint Anthony Hospital in Chicago, likes to call it operating "like a hospital without walls." For example, managers and directors are required to spend at least three hours a week in the community, interacting with leaders, elected officials, physicians, and police.
2. Finances are even more critical: Unlike AMCs or systems, independent hospitals can't rely on the corporate parent or market dominance to bail them out financially, and they certainly can't cost-shift. Good financial governance requires a delicate daily balancing act that enables you to move quickly.
3. Be aggressive in community outreach: You can't match the big players in marketing dollars, but you can use your community savvy to win hearts and minds. Saint Anthony weaves itself into the fabric of the community through such events as a community dialogue on how to fight youth violence from a religious perspective as well as a teen forum to help enhance community relationships through an art exhibit. It also hosts an annual custom car and motorbike show to offer employees and neighborhood residents an opportunity to showcase their prized possessions.