When Town Meets Gown

When Town Meets Gown

Historically, academic medical centers and private hospitals don't get along very well. So when the Nebraska Health System decided in 1997 to merge two hospitals—the (academic) University of Nebraska Hospital and the (private) Clarkston Regional Medical Center—it was a gamble.

A bad one, it seemed. By 2001, the system's cash reserves were depleted, earnings had fallen, and there was a small exodus of private practitioners. Cultural resistance between the two hospitals and their respective staffs was pervasive.

"I used to call them the Bloods and the Crips," says Glenn Fosdick, MHSA '76, who became CEO of the system in 2001. "We had a lot of challenges."

Seven years later, the Nebraska Health System—now the Nebraska Medical Center—is first in market share in the Omaha metropolitan area. Besides its primary facility, the center owns 49 percent of a 24-bed freestanding orthopedic hospital and recently broke ground for a 100-bed community hospital, 40 percent of which will be physician-owned. What's more, half of those physician owners will be from private practice and half from the university.

"I'm not sure there's another model like that anywhere," Fosdick says.

A past president of the SPH Alumni Society Board of Governors, a member of the advisory committee of the Griffith Leadership Center, and the 2007 recipient of the school's Distinguished Alumni Award, Fosdick spoke to Findings about the changes he's seen.

How did you turn things around?

We really focused on one basic entity, which is improving the product. Obviously that incorporates quality. It certainly requires working out the relationships between the two sides and getting them to work collaboratively, recognizing that competition is not internal, it's external.

But aren't the two sides inherently incompatible?

In our culture we have two different types of practice scenario, academic and private. It's like religion. Religions are all good. Having two different religions in your town has some advantages to it, but both of them have their unique needs, and you must respect them. And trying to jam them together doesn't work well. So we need to design our process and systems to ensure that we respect what's important to both parties.

It sounds easier said than done.

Our commitment to quality was huge. We took the stance that we should use best practices from other industries, like GE's six-sigma lean-manufacturing program. We changed our dietary system. We don't mass-produce 500 meals a day. When our patients are hungry, 24 hours a day, seven days a week, they call room service. We changed our entire supply system. We also implemented crew-resource management training, developed in the aviation industry in the 1980s because of a dramatic increase in fatalities in the '70s. We've trained our OR people, and we do checklists before surgery. We've expanded that to ER and the cardio-cath area and radiology, and we've seen great results. We measure every project by one of three criteria: it improves outcomes, improves efficiency or effectiveness, or it makes somebody's job easier.

Is the organization where you want it to be?

I don't think we're close to the level of quality that we should be. As an industry and as an organization we have a long ways to go. We have a perfect storm coming in the next four to five years, with more people retiring from medicine, nursing, and pharmacy than the health system can produce, and as the baby boom population gets into their retirement years, we'll have more and more people using acute care for their needs. And reimbursements are clearly not going to go up, they're going to go down. It's also clear societal expectations are going to increase.

How did your SPH training prepare you for this job?

The number one thing the program at Michigan did is make me appreciate what I'm really supposed to be doing at the hospital. At Michigan you're not only exposed to health administration but also to the public health side. You're taught as a hospital administrator that your primary job is to improve the health of the community. Now, part of that is to ensure the long-term viability of the institution. But part is to find new programs and medical services that aren't available and to figure out how to make them available, to work on preventive care, to work on education and research. That's all part of my job.

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