Q&A: Grady Health System CEO on Managing Through Crisis

Philip Betbeze, for HealthLeaders Media , March 28, 2011
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Young: In September, we opened a new neuro center [the Marcus Stroke & Neuroscience Center], we’ve redone our burn unit, and we’ve brought in additional cardiologists since so many of our patients are diabetic. We’ve done some marketing as well. Our Emory physicians recently shared seven-, 14-, and 30-day readmission data and found out that our clinical outcomes are as good as or better than national teaching hospitals in their treatment of diabetic patients. Those are big changes—for example, the neuro unit was a shell space where we built a world-class 18-bed ICU with the latest telemedicine technology, 24-hour EEG, and staffed it with one nurse for every two patients. We’re getting all sorts of patients that Grady hasn’t typically gotten in the past. We’re getting referrals from large providers. So that’s the level of confidence the outside world is starting to have about us. 

HL: How has the politically charged atmosphere changed at Grady?

Young: Outside-world turbulence, which is what I call it, is always a concern. Everyone feels like they own a piece of the public hospital, so you’re reporting to everyone. The accountants and CFO are spending a lot of time reporting to many more state agencies than a traditional hospital, all of which takes management away from the key focus. While I’m focusing on writing a report for someone, another CEO is focused on improving their managed care contract language. There’s an opportunity cost for that.

HL: What are some of the mistakes you have made in your tenure?

Young: Generally, in a turnaround situation, there’s not a lot of depth on your management team so you recruit people as fast as you can, but it’s really hard. So you just have to work a little harder, come in a little earlier, delegate more to your people, but two years ago no one would come to work here. I had one candidate for the VP position I had open at the beginning. The biggest mistake, in retrospect, is I didn’t act fast enough the first six months. I was maybe a little too evaluative, but now that I know the questions to the test, I should’ve been a little quicker. I would’ve spent a lot more time building partnerships, relationships, more administrative talent so I could delegate, but I’ve been wearing the CEO and COO hats and it’s been physically impossible to do all those things. I can’t tell you how many days I have 12 meetings on the schedule and miss six. Now we’re getting superior candidates. Two years ago, many of these people would have laughed if we asked if they would come to Grady. So you have to get those early wins on quality, get to normal operations, which allows us to recruit better people, allows me to delegate, and creates a positive upward spiral. I didn’t have time to talk to our county commissioners before, or even our board members. I had little time to network with docs or other people in the community, or to sit down and develop a managed care strategy because I didn’t have data, but I couldn’t negotiate a fair agreement without it. Now I have time to do those kinds of things.

HL: What can other hospitals emulate about a public hospital structure that would help them better deal with the risk aspects of healthcare reform?

Young: You don’t have to be a public hospital, but there’s a monumental advantage to the seamless delivery of care. Look at Geisinger, and it’s not just because of their health plan, but they have cradle-to-grave care. If you look at Lancaster [PA] General [where Young served as CEO more than a decade ago], they had made great strides in primary care and plugged in key specialty groups to deal with congestive heart failure and diabetes. That kind of tight integration is critical and it’s technology oriented. The value we have is that we have 10 primary care centers serving several hundred thousand people, and we have the Epic medical record and can manage their care more effectively because we have a closed panel of physicians, have the whole continuum of care. We’re still evaluating the health plan part.

Philip Betbeze is senior leadership editor with HealthLeaders Media.
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