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| Grady Health Center: Weight of the World |
| Cover Story | |||
| Written by Amanda Gaines | |||
| Saturday, 31 January 2009 | |||
 When Atlanta’s healthcare hub was in dire straights, community leaders stepped up and brought in a new CEO to push it in the right direction.
 Known throughout its region as a safety-net healthcare organization, Grady Health System handles more than 921,000 patient visits per year, employs more than 5,000, offers millions of dollars of indigent and charity care per month, and, as one of the largest employers in the city, has an economic impact on metro Atlanta of more than $1.5 billion a year.  Michael Young, CEO "The old model of being a straight-up traditional county hospital wasn’t working,” Young said. “A group of significant Atlantans got together and decided they would help save Grady by taking responsibility for the hospital’s management with a new board of directors and leasing the health system from the governmental authority that had run it for decades.” With the backing of the Robert W. Woodruff Foundation, the new board quickly raised $200 million in private capital (to be dispersed over four years) and committed to raising another $100 million through fundraising. With those securities in place, Grady brought in Young to carry the improvement process forward. “We’re rebuilding the hospital, the foundation, and our programs and using this $200 million gift to recapitalize the institution,” said Young. Direct hits Although $200 million is a large chunk of change, with nearly 30 years of hospital administration experience, Young knew it wouldn’t be enough to save Grady. “After 100 years, there were many things to change. $200 million is a lot of money, but it isn’t enough to replace everything,” he said. “It’s like fighting a war with only six bombs. You need to make sure all six hit.” In his first 100 days as CEO, Young helped the organization turn around its volume declines, increase its revenues and cash collections, and reduce patient length of stay. The first step in prompting change, he said, was reviewing the system’s programs. In addition to handling Atlanta’s only 911 ambulance service and Level I trauma center and Georgia’s only poison center, Grady comprises 953-bed Grady Memorial Hospital, 10 community health centers, one of the nation’s largest burn units, and a regional perinatal center and NICU. When Young and his team did a line-by-line analysis of what was working and what wasn’t, they overwhelmingly found a lack of communication and a system plagued by silos. “Throughout my 25 years in healthcare, I’ve found institutions won’t work effectively when departments are siloed and segmented,” he said. “They don’t understand how their operations impact the downstream departments. And with frequent changes in leadership, people at Grady were afraid to make decisions, so no progress was being made.”  Some of the system’s biggest challenges and greatest successes initially occurred in the hospital’s ED, which in the past struggled to get patients to their appropriate departments and often housed patients overnight. Between September and early December, there was only one reported case of a patient spending the night in the ED, and patient volumes in the department have increased 2.5%. “The solution came from a radical idea,” said Young. “We sat all the ED players down at 8:00 every Monday morning in the boardroom, reviewed operations and issues, and assigned tasks for the upcoming week,” Young said. “As a result, we’ve seen our wait times shrink, and we’ve been on divert status less often.” Diamonds in the rough The breakdown in communication went beyond the ED, however. Young realized the years of leadership instability and institutional bureaucracy had resulted in a lack of cohesion across the system, best illustrated through the challenges at the clinics. “The people at the clinics had no idea what the people in the EMS were doing, the EMS people had no idea what the people in the hospital were doing, and no one knew what was happening at the medical school,” he said. “Patient throughput was poor, and it was impossible to schedule visits. It was an information vacuum; we didn’t have any best practices—we had worst practices.” To break down the barriers built on years of misinformation and a revolving door of CEOs, Young developed and delivered a clear message and spread it across the system through State of the Hospital addresses. His message was simple. Rule #1: the patient is always right. Rule #2: if the patient is wrong, please see rule #1. “We need to treat our patients like they’re our mothers because without our patients, we have no future,” Young said. “The message is that we have to grow to survive, the old way guaranteed failure, and it’s time to move on.” Young then instituted a program called Please Ask through which employees can ask any question. Young responds to each question and posts his responses for all to read. In addition to holding weekly ED meetings, he reinstituted department head meetings and began meeting with the deans of the colleges that staff all of Grady’s physicians: Emory University and Morehouse. “Our physicians are our VVS-grade diamonds, and we needed to figure out how to remind people that our diamonds are shinier and of better quality than other organizations,” Young said. “With all faculty doctors and no private physicians, we needed to make sure we were on the same page as the institutions providing us with those jewels.” Gold seal of approval This November, Grady Memorial Hospital, Crestview Health and Rehabilitation Center, and Grady’s behavioral health program received full Joint Commission accreditation. When the organization was surveyed the year before, the result was several improvement recommendations. The result of the impromptu visit from Joint Commission surveyors this year was a gold seal of approval. “The results of the survey are proof that Grady is doing it right, effectively, and in the spirit of community, leading to the provision of the best quality care for its patients,” said Young. “Full accreditation from the Joint Commission is validation that our ongoing efforts to meet and exceed national healthcare and patient safety goals have been successful.”  In alignment with its strategy to support safety-net organizations in Atlanta, Kaiser Permanente of Georgia granted Grady $5 million this year: $3 million will go to funding 1,000 low-income and uninsured patients with chronic illnesses, $1.5 million will go toward purchasing 10 “green” ambulances, and the rest will be used for equipment for the Level I trauma center.The support Grady has received is a testament to its value in the community. In the same vein, Young’s response to the progress the system has made is a testament to his focus on improvement. “We have some of the best clinical outcomes in the city, but some of our equipment looks like a MASH unit from 1962,” he said. “Because our doctors and nurses are so focused, our clinical outcomes are excellent, but we’re not at the end of the race yet.” Next in line is the implementation of a system-wide EMR. For many healthcare organizations, the process is a challenge, particularly in getting physicians on board. But because Grady’s physicians were all trained at two of the most prestigious and innovative medical schools in the country, the situation is a little different. “The bulk of our medical staff is Emory University doctors who have EMRs at their hospitals,” Young said. “They’re kicking me in the backside to make sure we get the EMR done on time.” Although some of the facts and figures from Young’s initial days at Grady have changed, what hasn’t is the fact that more than 5 million people rely on Grady for their healthcare needs. “I feel more than a little pressure because if we fail, the entire Southeast US healthcare system fails,” Young said. “Last year, I had 5,000 families who depended on me in Buffalo. Now I have the care of 5 million people on my back. I don’t have a hard time getting up in the morning.” |
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