William F. Groneman has faced some tough situations in his 15 years as a healthcare executive.
None will be more difficult than helping Cincinnati-based Bethesda Hospital continue to prepare for healthcare reform while meeting its community's needs.
But Mr. Groneman, 39, doesn't mind the challenge. In fact, he wouldn't want it any other way. "(There aren't many jobs in which) you can give something back to your community and do it every day in the course of your work," he said.
Mr. Groneman "instinctively knows how to mobilize others to achieve the desired results," said L. Thomas Wilburn Jr., Bethesda's chairman, president and chief executive officer. "He's the kind of person that any of us would like to have on our side if we were going into battle."
For his management efforts, Mr. Groneman has been named Young Healthcare Executive of the Year by the American College of Healthcare Executives. The organization will honor him at the Arthur C. Bachmeyer Memorial Address and Luncheon during ACHE's 37th annual Congress this week in Chicago.
As senior vice president and chief operating officer of Bethesda's 432-bed Oak Street facility on Cincinnati's east side, Mr. Groneman last year helped the two-hospital system establish a joint venture with crosstown rival Good Samaritan Hospital, and ChoiceCare, a local managed-care operator. Bethesda also operates a 314-bed suburban hospital-Bethesda North-on the city's fast-growing northeast side.
The fledgling organization, called NewHEALTH, hopes to revolutionize the way area consumers pay for healthcare as well as build a long-term partnership between the hospitals and the HMO's 2,000 physicians.
Mr. Groneman expects to help lay the groundwork for an organization that will work to lower healthcare costs, eliminate unnecessary duplication of services and improve quality of care. NewHEALTH eventually will be serving a metropolitan area of more than 1 million residents in the Cincinnati tri-state region, which includes northern Kentucky and southern Indiana. A total of 32 hospitals operate in the region.
The job will require all of Mr. Groneman's management skills, as he will have to help Bethesda and its physicians fashion new relationships with Good Samaritan and its physicians, ChoiceCare's physicians as well as other providers and insurers in the region.
Mr. Groneman holds a bachelor of arts degree from Brown University, Providence, R.I., and a master's degree in hospital and health administration from Xavier University, Cincinnati. He's had a positive impact on Bethesda since returning to his hometown from Colorado in 1987 to begin a four-year stint as senior vice president and COO of Bethesda North Hospital.
During his tenure at the suburban facility, gross revenues more than doubled to $136 million in 1991, compared with $64 million in 1986.
Under his management, the facility's inpatient market share rose 1.8%, which was sparked by a 7% rise in admissions, a 39% jump in surgeries and a 17% increase in emergency department visits.
To increase surgeries at the hospital, Mr. Groneman introduced three freestanding suburban diagnostic facilities and an ambulatory surgery center.
He also initiated maternity services, including high-risk nursery services, at the hospital in 1991. Almost all of the city's maternity beds had been clustered at several hospitals just north of downtown Cincinnati. Bethesda North had more than 2,000 deliveries in 1993, nearly all new patients rather than transfers from Bethesda Oak. At the same time, Bethesda was registering high levels of inpatient satisfaction.
When planning such services, Mr. Groneman said the hospital had to carefully weigh their merits against the needs of the community. Although hospitals must always scout for new sources of revenue, the primary concern should be how well the community will be served, he said.
A hospital administrator has to toe the line as a steward of the public's trust as well as an auditor of the bottom line. "That balance doesn't always come easily," he said.
That has never been more apparent than today, when hospitals are fast becoming "cost centers," as so many former inpatient services are being shifted to outpatient systems of care, he said.
His perspective on the balance between the business and social service aspects of hospital management guided him as he successfully worked with the medical staff to increase appropriate use of a magnetic resonance imaging center adjacent to Bethesda North. The nearly insolvent facility, which lost some $250,000 in 1987, posted an operating profit of more than $600,000 in 1991.
Such success demonstrates Mr. Groneman's ability to motivate others to make needed changes in the organization, Mr. Wilburn said.
In March 1991, Mr. Groneman was tapped to help turn around Bethesda Oak, an urban teaching hospital that lost $7 million that year.
Through quality management planning, Mr. Groneman was able to improve corporate productivity even though that also meant reducing full-time staff levels at both hospitals by 11% to some 2,800.
Decisionmakers "sometimes have to be brutally honest," he said. "There's a risk in being out front. Some may think you're responsible for creating bad news," he said.
Mr. Groneman's ready smile and "can-do" attitude gradually helped raise staff morale and eventually won the confidence of the hospital's physicians. In 1993, Bethesda Oak reported gross patient revenues of $133.9 million and net patient revenues of $98.4 million.
Throughout his career, Mr. Groneman hasn't shied from instituting change and innovation, said Sister Myra James, president and CEO of Good Samaritan Hospital.
For example, while vice president for ancillary services at Penrose Hospitals, a Daughters of Charity facility in Colorado Springs, Colo., from 1984 to 1987, Mr. Groneman established a joint venture between the hospital and its radiologists, she said.
"His sense of fair play, honesty and integrity" helped him transform many difficult situations into positive outcomes, she said. "In recent negotiations with Good Samaritan Hospital, ChoiceCare and Bethesda Hospital, it is again a pleasure to work with someone who is bright, energetic and interested in getting the job done in an honest way."
Under his leadership, the system has moved aggressively to establish Cincinnati's first comprehensive behavioral health service, which uses a case management approach to coordinate inpatient and outpatient care.
The service operates the nation's largest hospital-based employee assistance program and covers more than 200,000 people in capitated, or risk-based, payment arrangements.
The hospital's experience with lower-cost alternatives to inpatient mental healthcare should help prepare it for the changes that lie ahead in acute care, Mr. Groneman said.
Bethesda's planned venture with Good Samaritan and ChoiceCare carries a lot of risk for everyone involved, he said.
Some physicians understandably feel threatened as they face the likely loss of independence with the formation of physician groups. Bethesda and Good Samaritan have begun to organize selected physicians into group practices to prepare for integration.
But a fully integrated system is still a long way off. "You have to slowly develop trust in your partners," he said. In addition, "You have to create situations where everybody feels they'll benefit (from change)," he said.
Despite the risks that lie ahead, "healthcare can be a phenomenally exciting area if you can deal with the ambiguity," he said.
His advice to anyone who is considering a healthcare career: "Don't think about hospitals, think about healthcare. The future is in group practices, managed care and case management."