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St. Francis Reinventing Itself

New Patient Tower, Suburban Strategy At Core Of Plan

By Greg Bordonaro

September 06, 2010

When St. Francis Hospital and Medical Center officials began mapping out a strategic plan about a year ago, the economy was still in shambles, sweeping health care reform was on the verge of passage and the future of the industry remained cloudy at best.

So how did the hospital’s CEO Christopher M. Dadlez prepare his top lieutenants for what seemed like an impossible task? He assigned them to read The Innovator’s Prescription, a popular book among health care visionaries that calls on the industry to completely transform itself.

That’s exactly what St. Francis Hospital is aiming to do, with an emphasis on expanded emergency services, a suburban strategy that embraces preventative medicine and a medical home model, cost containment and more comprehensive care for the patient.

“We decided not to take a traditional strategic planning approach where you just interview hundreds of people and get the common denominator and say this is where the world is going,” Dadlez said in a recent interview. “We needed to completely rethink our position in health care.”

As the health care industry begins to change dramatically following the passage of the Patient Protection and Affordable Care Act in March, hospitals, physicians, and other providers are beginning to rethink their role in the system, and prepare for a world that demands far more efficient care and receives smaller reimbursements from government payers.

St. Francis Hospital, one of Hartford’s largest employers with nearly 3,500 workers, is preparing for the brave new world with a strategic plan that calls for a more patient-centric model and the development of accountable care organizations, or medical homes. Future suburban build out — an effort to grow more low-cost alternatives to the emergency room — is also a key part of that strategy.

The hospital’s main campus in Hartford will also play center stage in the future growth of St. Francis with the opening of a new 11-story patient tower in the spring, which could alter the market for emergency services.

But preparing for reform and the future isn’t always easy. The hospital recently announced that it is laying off 200 workers, a decision Dadlez said is being spurred in part by the economy, but also by future

“We are trying to right-size the hospital for anticipated health care reform changes, which will mean lower reimbursements on Medicare,” Dadlez said in his first public comments about the layoffs. “We are cutting our budget and trying to retool the volume we have here in order to make sure we are around in the future. It’s tough, but all hospitals in the state are going to have to be doing it.”

At the center of St. Francis’s strategic plan will be a new, 11-story patient tower, scheduled to open next spring.

Dadlez said there has been a huge growth in demand for emergency services. St. Francis is seeing about 70,000 visits a year, creating cramped conditions that force some patients into hallways. The hospital’s emergency department, which is built for 30,000 patient visits a year, simply can’t handle the load.

The new 385,000-square-foot state-of-the-art facility, which is part of a $185 million investment, doubles the size of the emergency department and will be able to accommodate up to 100,000 patients a year. It will also boost the private bed count at the hospital to 70 percent of the 617 total. That will be key in growing the hospital’s patient base and reducing the spread of infectious diseases among patients.

“This allows us to bring the rest of the campus into the 21st century,” said Chris Hartley, St. Francis’s senior vice president of planning and facilities development. St. Francis opened another 10-story patient tower in 1996.

The emergency department within the new tower will include 66 exam/treatment bays, four triage rooms, 13 ambulance bays and staging areas and shell space for future growth. The tower will also house St. Francis’s Joint Replacement Institute, which will include six operating rooms at 650 square feet each, a fresh tissue lab, and 22 recovery bays. It will also have a new helipad.

Dadlez said the new tower will improve patient satisfaction and make St. Francis stand out among its neighboring peers, particularly Hartford Hospital and the UConn Health Center. But boosting market share is not necessarily a top priority.

“We are not really out there ferociously competing,” Dadlez said. “I think there is plenty of business for ourselves, Hartford Hospital, and the UConn Health Center.”

Dadlez said the future of the industry is not about volume, it’s about value

“Before the strategy by many hospitals was to grow, grow, grow and see as many patients as possible,” he said. “That’s not the future. The future is about determining how you can take care of the community most effectively to keep patients out of the hospital. We are going to be paid to manage populations.”

To meet those changing demands, St. Francis is changing itself to be a more patient focused hospital that can better manage heath care over an entire lifespan. That means beefing up preventative and chronic care services, and/or partnering with other organizations on services that its lacking, like long-term care.

Plans also call for more development in the suburbs, particularly opening additional ambulatory centers, which provide a low cost alternative to the emergency room. There is a particular opportunity for growth in the Farmington Valley, Dadlez said.

St. Francis Care, for example, recently agreed to house some of its doctors in the Dorset Crossing development on Route 10 in Simsbury, which is about to break ground on an outpatient medical facility.

St. Francis recently opened another facility in Ellington.

Ambulatory centers are hubs for primary care physicians and specialists. Dadlez said St. Francis would like to mold those suburban centers into accountable care organizations, or medical homes, which are a key part of the health care reform strategy.

The idea is to use primary care physicians as central figures in coordinating patient’s care among specialists, hospitals and other health care providers. That reduces costs in the long term by eliminating duplicative care and encouraging preventative services that help to root out serious diseases or health problems before they develop.

Many hospitals are looking into the model, and both the state and federal government are pushing for its development.

St. Francis is leveraging those changes with an investment in a Primary Care Institute, scheduled to open this fall. The institute, to be initially based on the hospital’s Hartford campus, will be a research hub that aims to study the future role of primary care physicians in the state and teach doctors how to manage large populations.

Cost control is a big factor. St. Francis is taking a page out of the private sector by adopting “lean” principals, a discipline commonly used in manufacturing for streamlining and efficiency. The hospital is working to cut patient wait times, among other things.

St. Francis Hospital’s strategic plan has as much to do with necessity as it does opportunity.

Connecticut hospitals are likely to see lower income because of health care reform. When the legislation really kicks in 2013 and 2014, state hospitals, if they do not change their current business model, would see their margins plummet to a negative 4.5 percent, from the current slim 1 percent margin, said Dadlez, citing industry research.

“We are being forced to change, but we also have to foot the bill for it,” he said.