When it comes to creating a positive environment in which employees, managers, physicians and executives are given opportunities to blossom and succeed, A. Gus Kious is an expert.
In his three years as chief administrative officer of 183-bed Huron Hospital, an inner-city teaching hospital in one of the nation’s poorest neighborhoods in East Cleveland, Ohio, Kious has created a new culture of teamwork while clinically turning around the hospital.
“I am very proud of my management deployment and nontraditional management approach,” says Kious, who is often seen walking through the hospital wearing cowboy boots and a big hat. “I look out there and see happy people doing what they love.”
Compared with the 11 hospitals that are affiliated with the Cleveland Clinic Health System, Huron has the third-lowest average length of stay at 4.47 days, and the best supply costs per adjusted hospital discharge at $639.
Among his other accomplishments, Kious also has lowered indirect cost per patient case in the past three years 20.3% to $3,024 by challenging physicians and staff to performance excellence and creating a chronic-disease management program that has decreased amputations by 48% to 25 in 2006.
“Dr. Kious has had a rich focus in working to the community and doing the right thing. He is committed to breaking down the barriers and cutting through red tape,” says Michael O’Connell, Huron’s vice president of operations and physician services.
Kious, a family physician who sees patients every two weeks in the hospital clinic, also leads by example. O’Connell once observed Kious spot a scuff mark on a hallway floor. “He stops and removes it. Housekeeping notices that,” he says. “Another time he sees an aide in the ER who has the same kind of car he does. He talks it over with him. There is a respect and rapport with people that they appreciate.”
In recognition of his ability to create a team atmosphere, the Medical Group Management Association and American College of Medical Practice Executives have chosen Kious as their 2007 Physician Executive of the Year. He will receive the award at the MGMA’s annual conference Oct. 28-31 in Philadelphia.
“I was absolutely shocked and first thought it was a trick,” Kious says. “It is an honor because we have worked in a focused way to change the culture at Huron. The people here made it possible for me to win this award.”
Kious calls his nontraditional, two-tier management structure a “bottom-up approach.” The first tier is called the Operations Council, a diverse group of middle managers who meet weekly to solve problems involving patients, quality and safety. “This council makes the hospital operate,” Kious says. “The vice presidents tell them what the problem is and the middle managers solve it. I tell them, if you want us to be around, we must succeed. If not, we will fail.”
The second tier is the 12-member executive team. “We discuss issues of strategy and debate policy. We are there to support the Operations Council,” Kious says. Executive team meetings have two parts. First, each senior executive takes turns giving updates. The second part involves problem-solving or discussions.
“We have an upside-down management structure,” Kious says. “The success of the organization is due to the people running the place. My main role is to take on blame and help people achieve. This has allowed us to achieve operational excellence. Middle managers are enthusiastic about the business.”
Kious became interested in becoming a doctor only after he received a bachelor’s degree in criminal justice in 1967 from the University of California at Berkeley, and then spending three years teaching students as a missionary in South Africa. He met his wife, Janet, there. They have four children. As a teacher, however, Kious started speaking out against apartheid in South Africa. The government designated him an undesirable visitor and gave him 30 days to leave the country or be arrested. “I came back to the States and decided to become a doctor,” he says. “I always had great respect for them.”
After receiving his medical degree in 1977 from Case Western Reserve Medical School and finishing his residency at Fairview General Hospital, Cleveland, Kious practiced medicine for the next decade. He was team physician from 1983 to 1987 for the Cleveland Indians. In 1990, he officially began his management career, first as medical director with Prudential Healthcare of Northern Ohio and then accepting a job as senior vice president for medical operations in 1996 with Meridia Medical Group, a multispecialty group practice. In 1997, Meridia affiliated with the Cleveland Clinic.
At Huron, Kious knew he had to quickly fix a serious overflow problem in the emergency room and reduce lengths-of-stay on patient floors to eliminate frequent ambulance diversions. With the hospital closed to new patients an equivalent of 162 days in 2004 because of a lack of beds, Kious asked physicians for help.
First, Kious developed a care-coordination program to, in part, expedite discharges. Second, he hired a hospitalist group to take care of uninsured ER patients. He also met individually with physicians with high average lengths of stay. “I explained how this was affecting operations,” he says. “They groused a bit, but they all made changes and improved.”
Despite reducing per patient costs, Kious says the hospital is projecting an $8.5 million loss on net patient revenue of $100 million for 2007. “We are losing less money, but uncompensated care is growing” by $38 million, he says.
To improve productivity and reduce costs, Kious has cut the workforce by 8% over the past three years to 1,000 employees. “I had to let people go. I don’t think firing people is that hard. It is sad. When you decide that leadership needs to change, you have to make those decisions that are best for the organization,” he says.
Jay Greene is a former Modern Healthcare reporter and now a freelance healthcare writer based in St. Paul, Minn. Contact Greene at [email protected].
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