Richard D'Aquila, president and COO, is committed to directly communicating with employees and the growth of YNHH has not stopped him from scheduling open forums on all shifts for the convenience of employees.
In 15 open forums since November, D'Aquila has re-capped year-end performance and discussed areas of focus for FY14. He also asked attendees what rumors they were hearing so he could confirm or dispel them.
In FY13, volume exceeded 80,500 inpatient discharges, up 3 percent from last year and outpatient visits totaled more than 1.08 million, up 4 percent. This was the first year that volume on the Saint Raphael Campus was included.
"No other hospital in Connecticut is seeing this kind of growth," D'Aquila said. "Volume continues to be our friend and our expenses are growing at a pace that is less than our revenue growth. You are part of an organization that patients are still choosing for their care in increasing numbers. You should be proud of that."
D'Aquila pointed out that patient satisfaction was a less rosy story for YNHH. He attributes stagnant scores to the Epic conversions and noted virtually all hospitals who have implemented Epic have experienced a temporary dip in patient satisfaction while staff become more conversant with the tool. For better scores in 2014, he urged employees to concentrate on three basics: reduce the noise on the units; improve communication with patients and between clinicians; clean and de-clutter the hospital.
The operating margin for FY13 was 4.5 percent, down from FY12's 6.1 percent. He noted that between January and October 2013, YNHH absorbed an unexpected cut of $30 million because of state cuts to Medicaid.
"Our financial performance is spectacular, considering the unforeseen cuts we absorbed," D'Aquila pointed out. "We would not have been able to achieve this without the integration of the Hospital of Saint Raphael which provides us with increased scale.
"Without a healthy operating margin, we will not be able to continue to invest in our people, our services and programs and renovations," said D'Aquila.
Plans for musculoskeletal and ambulatory
At the forums, D'Aquila spoke frequently about the musculoskeletal center based at the Saint Raphael Campus, which he called a "destination" service. Plans are under way to prepare that campus to accept more orthopedics and spine patients, including the opening of the newly renovated inpatient unit on Verdi 4 North, the ORs on that campus and refurbished orthopedic patient rooms in the Grimes Center.
D'Aquila stressed the need for an all-hands-ondeck approach to safety.
Last year, YNHH reported 79 preventable events that affected or compromised patient safety. In 2014, employees can expect to focus in many areas to improve patient safety: falls with injuries, pressure ulcers, hospital-acquired infections and wrong-site surgeries.
"We must get these numbers to zero and every employee has a role in making this a hospital where no harm comes to patients," he said and pointed out the complementary relationship between cost and value positioning and delivering better patient outcomes safely and without waste.
D'Aquila also pointed out that a little farther out on the timeline from the musculoskeletal center is an effort to develop a venue that consolidates services for outpatients currently served at York Street, Saint Raphael Campus and Temple Medical Center. This will provide a unique and patient-focused environment for ambulatory patients that will help parking which gets tighter by the day.
Rumors and questions
In addition to the updates, D'Aquila asked employees for rumors they were hearing. Some of the questions and his responses follow:
- Is the ED on the Saint Raphael Campus going to close? "No way. Extremely complex emergent care will be concentrated on the York Street Campus. For the vast majority of emergency care, we need both EDs to meet the needs of our community."
- How do you see the Affordable Care Act impacting YNHH? "I expect patient bad debts will increase. Patients are going to have higher deductibles and more and more expensive co-pays. They are going to pay more for health care than they have in the past and are going to be more demanding of providers like Yale-New Haven which is why we have to enhance the value of the care we deliver to them."
- Are you going to lay off employees? "We have no plans to lay off employees. We do everything possible to avoid layoffs by being very careful about filling vacant positions and maintaining a cushion for unanticipated financial emergencies."
- What trends to you see in health care? "We are going to be paid less for treating more patients, which means we have to be more serious about the quality of our care, the quality of the environment where we deliver care and that we demonstrate quality and value to the consumers of our care."