Rebuilding a hospital's reputation

For years, 49-bed McDowell Hospital in Marion, N.C., was a facility that people would go out their way to avoid. Residents of the town and surrounding rural area in the far western part of the state would more likely drive 35 miles to 744-bed Mission Hospital in Asheville, N.C.

The reasons McDowell was spurned included long lines for treatment, a shabby facility, outdated equipment, and a well-deserved reputation for subpar quality of care and dismal customer service, says McDowell's new CEO Lynn Boggs. The hospital had been operating in the red for years and was on the brink of closure in the mid-2000s. It was saved only through an acquisition in 2004 by Mission Health, the owner of its main rival, Mission Hospital. The health system invested $22 million over seven years to cover operating and capital costs, including new technology.

Even Harold Walker, 60, a member of the not-for-profit hospital's board from 1998 to 2002 who returned to the board in 2010 and served as chairman until the end of 2013, said he avoided using McDowell when his sons were born in the late 1970s. Walker, a lifelong resident of the community, said he couldn't trust that the staff would be able to provide the care his wife would need if something went wrong.

Walker's background is in banking, having held several senior positions during his 28-year tenure at First Citizens Bank in Marion, including his current role as market executive. Before First Citizens, he worked for 10 years at another bank in Marion. Between his banking background and the fact that he had been in the community all of his life, Walker said he believed he knew how to help transform McDowell Hospital into a better healthcare provider.

Walker is widely credited with leading that turnaround. For his accomplishments, he is Modern Healthcare's 2014 Trustee of the Year for small hospitals, those with fewer than 100 beds.

In 2011, during his tenure as vice chairman of McDowell's board, Walker joined the CEO search committee that led to the hiring of Boggs, a registered nurse and executive with more than 35 years of experience in healthcare administration. She was brought in to replace Edward Hannon, who had resigned as CEO that year. At the start of 2012, Walker became board chairman; Boggs formally started her duties in February of 2012.

“We realized together that we faced some uphill battles,” Boggs said. “Our quality scores were abysmal.”

In consultation with the board, she immediately turned her attention to improving customer service through simple steps such as separating the check-in points for ambulatory and inpatient services, reducing prolonged wait times in both departments. She also worked to change the patient experience by silencing intercom pages and requiring staff to communicate through new approaches that were less intrusive on the patient floors.

Capitalizing on his close ties with the business community, Walker also focused on developing new services, including having McDowell offer a more comprehensive occupational medicine practice that would provide health and wellness programs to small businesses, corporations and the community at large. Services include workers' compensation injury management, drug screenings and health fairs. “We needed to reach out,” Walker said. “We have a lot of industries in the area and they need a healthy workforce.”

Before the new service lines, the hospital was working with “nearly zero” local manufacturers and other businesses, Boggs said. Today, McDowell has relationships with 51 companies.

Another way Walker worked to rebuild trust in the hospital was to begin what he calls fireside chats in the community to keep residents up to date on issues such as healthcare reform. Both he and Boggs participate in the events. “Healthcare is changing and a lot of people don't know what those changes are,” he said. “The hospital has to be the leader in educating the community.”

Walker also has worked to improve the relationship between McDowell and its parent, Mission Health. For years the relationship could be characterized as an “us versus them mentality,” said Dr. Ronald Paulus, president and CEO of the health system. McDowell turned to the system when it needed financial support or a place to refer more complex patients, Paulus said. But there was limited collaboration in other areas.

When the health system acquired the hospital, the objective was to bring new resources and services to the community while allowing the hospital to continue operating independently. But relations between the two entities were still strained.

Paulus said the situation began to turn around following a board meeting during which Walker stood up and pointed out to his fellow board members that McDowell and Mission Health “were in this together” trying to navigate the rapidly changing healthcare landscape and that they needed to become more integrated to make the relationship work.

Soon, back-office functions such as marketing and finance were centralized, just one of the changes that helped slash costs at McDowell. By the end of the hospital's fiscal 2013, financial and quality initiatives introduced by Walker and Boggs helped the hospital to post net income of $900,000, up from $50,000 the year before. Previously, the hospital had been operating in the red for many years. Last year's margin was the largest the hospital had generated in decades, Boggs said.

The community has noticed that the investments are paying off. “There has been a remarkable turnaround in public perception from negative to quite positive,” said Marion Mayor Steve Little. Not only does the hospital have a better appearance, but he believes residents are expressing greater confidence in seeking care at the local hospital. “People are aware that there is higher level of care overall,” he said.

Next on the hospital's agenda is construction of a replacement facility, still in the planning stages and estimated to cost about $40 million. When Boggs took over as CEO, she said the hospital had more modest plans to remodel the facility with an increased capacity for outpatient services. But after looking at the plans, Boggs realized it would be cheaper to start from scratch. To do that, however, the hospital needed community support, and that's where Walker came in.

“There was a lot of conversation in the community,” Boggs said, with questions raised about the need for new construction at the hospital, which is about 35 years old. With his business background and longstanding connections in the community, Walker was able “to get out and tell the need for a new facility,” she said.

She hopes the new hospital can be open for business in about 18 months.

Follow Virgil Dickson on Twitter: @MHVDickson