Young: The crisis was so severe that the answers were pretty plain. In public hospitals, employees often don’t recognize that they need to collect cash and get patients to pay what they can or the public hospital doesn’t exist anymore. Before, it seemed to them that there was always unlimited cash and it didn’t matter. Now the cash is limited but the patient flow is not, and it produces conflicting expectations for the employees. So we’ve gotten them to understand that if the hospital’s not economically healthy, then they’re not going to personally be economically healthy. That doesn’t mean turning people away [who need care]; it means you ask people to pay and you find out if they actually have insurance. You share with the employees that there won’t be another pay increase until the hospital gets into the black. That produces a pretty remarkable cause and effect. Now that we’ve had some success, we’re getting into the slower, evaluating, collaborative model. Once you’re rescued from drowning and you’re back on shore, you take lessons so your stroke is perfect next time in the water. In the same way, we’re taking longer to make decisions, including more folks, and starting to compromise.
HL: Was Grady’s clinical quality subpar?
Young: Most [financially] weak hospitals have clinical challenges. I don’t mean necessarily that their infection rates are higher or that people die there who shouldn’t, but the whole process of care does not run smoothly. So there’s delays from place A to place B, from the nursing unit to the OR, from the OR to the patient room, so as a result, such hospitals often do produce higher length-of-stay metrics and experience higher costs per case. The whole hospital factory doesn’t work well. Often it means care’s not where you want it to be. I’ve experienced that. But I was pleasantly surprised where Grady’s clinical outcomes stood, benchmarked against regional and local benchmarks, so we didn’t have to spend much energy there.
HL: What kinds of strategies have you deployed to improve Grady’s prestige among the area’s clinicians and patients?