Big System, Big Problems
Jackson's turnaround is a big story for a lot of reasons. For one, public safety net hospitals are often poorly reimbursed compared to their competitors, but it's mostly a big story because of how deep in the red the organization was, how it had become a national laughingstock for incompetent management, and simply because of how big it is. The main hospital, Jackson Memorial, has 1,550 licensed beds, and it's only the biggest of six hospitals in the system.
Migoya came aboard as the hospital evaluated a takeover offer from a for-profit suitor. The offer was billed as a billion-dollar effort, but Migoya says it really amounted to assuming Jackson's huge debt and committing to making capital expenditures for several years. No cash.
"It was essentially takeover payments, like they say in the car industry," he says.
Migoya convinced the board to let him and his team try to crack the problem before making any rash decisions such as selling out.
"When I got here, there was little accountability, and little control over what was going on," he says. "Frankly, sad to say, very few department managers knew their budgets, much less where they stood against them."
Thankfully, the level of clinical care quality was high, he says, freeing him up to make administrative moves that he was confident would turn the financial tide. Migoya put together a leadership team made up of individuals who were used to accountability and put them to work overhauling the rest of the senior administrative staff. He says hiring the right chief operating officer and chief strategy officer were his best decisions.