Focusing simultaneously on short-term financial goals and long-term strategic goals can stretch any chief executive officer. But David Wallace, president and CEO of Brown County General Hospital in Georgetown, Ohio, has managed to straddle both since being appointed to his position in 1998 at age 33.
"When your back is against the wall with financial struggles of losing about 2% (annually), you don't typically take on something like patient satisfaction," says Wallace, now 37. "You typically buckle down and say, `We have to work on expenses.' Which we did, but we also realized there was a much bigger-picture transformation that needed to take place at the hospital."
Everyone's eyes opened to the need for that when Wallace asked top managers where they figured the 53-bed facility, located in a rural area 60 miles southeast of Cincinnati, would fall on the Press Ganey Associates patient-satisfaction scale.
"They all guessed 50th, 65th, 80th, 90th-and we were at the 3rd percentile," Wallace says. The hospital started sharing patients' comments with all departments. "Initially, they were eye-opening," he says. "The negative comments you really learn from."
Since then, Brown County General has improved satisfaction to the 91st percentile while increasing net revenue by 36% over five years. Wallace credits Rick Ament, former group vice president at Quorum Health Resources, the management firm with which the hospital contracts (and Wallace's ultimate employer), with helping him adjust to being a turnaround CEO.
"It was not something I would have described myself as at that time," he says.
Ament, who left Quorum in June to become chief operating officer of Covenant Healthcare System, quibbles with that description. "He's not a turnaround expert. He's leadership expert," Ament says. "Anybody can hire a hatchet man to come in and clean house; then they've got to leave. Dave's presence is stronger there than it's ever been."
Prior to Wallace's arrival, employees nearly decided to unionize. "A lot of times there are legitimate issues employees have about how managers are treating them or how co-workers aren't pulling their weight," he says. He quelled that dissatisfaction by hiring a full-time human resources manager to handle gripes and focused staff on patient care via a regular weekly meeting specifically on the subject.
Rob Robinson, vice president of patient-care services and chief nursing officer, says Wallace encourages managers to challenge his direction and to be autonomous in running their departments.
"One thing you used to hear is, `People are afraid to say anything,' " Robinson recalls. "He has created an environment where people feel free to question things."
Not everyone has been comfortable with "this new expectation that the old ways of doing business were not the way we were going to continue to do it," Robinson adds.
The hospital has seen significant leadership change since Wallace took over, with about three-quarters of the 30 middle- and senior-management positions turning over. "We didn't do any layoffs, we didn't do a lot of terminations," Wallace says. "Although a lot of those things are, do you call it a termination, or do people see the handwriting on the wall?"