Sentara: Patient-centered care key to turnaround
By Jon Hawley
Sunday, March 24, 2019
Talk to officials for both Sentara Albemarle Medical Center and Pasquotank County, and they'll generally tell you the hospital is doing well today.
Patient numbers are growing, quality of care is high, employee morale is generally good, and the hospital is financially stable even after large sums were spent on modernizing facilities and technology.
All of that would have been hard or impossible to say before March 2014. This month marks the five-year anniversary of Sentara taking control of the facility formerly known as Albemarle Hospital.
In interviews last week, Sentara Albemarle President Coleen Santa Ana and leading hospital staff reflected on the milestone, and explained how they've worked to improve all aspects of the hospital for Albemarle residents.
Albemarle Hospital was in bad shape in 2012, when Pasquotank County commissioners and the Albemarle Hospital Authority decided to lease the hospital to a larger health system. The hospital suffered a $4.5 million operating loss that fiscal year, leading to $4 million in cuts and 42 layoffs in early 2013. In the years prior, the hospital had seen shrinking revenues, difficulty finding doctors, and had struggled to make needed investments while carrying large debt for upgraded facilities.
Vidant Health operated the hospital then under a management agreement, a pact that county officials found didn't allow the investment or efficiency that fully joining a large health system would.
Responding to Pasquotank’s request for offers, Sentara, Vidant, Duke LifePoint and four other systems made their pitches to operate the hospital in late 2012.
Taking over the struggling hospital was a risk, but also a great opportunity, Santa Ana explained. Working as a senior strategist for Norfolk, Va.-based Sentara Healthcare at the time, she knew Albemarle Hospital's challenges — but also the many patients in its service area that Sentara was well-positioned to serve, if not serving already.
“This is a community that Sentara always felt strongly about serving already, even without a direct hospital in town, and a lot of folks were choosing to drive to Virginia for care,” she said.
Santa Ana also noted that, well before 2012, Sentara had competed for the management agreement that Vidant ultimately won.
In seeking the lease, Sentara also felt it had a good handle on the risks involved, in part through working out clear expectations for investment from county officials, she explained.
Many — but not all — county residents and officials voiced their support for Sentara during the lease negotiations, often citing it as a known and trusted provider. Though finalists Vidant and Duke LifePoint made competitive offers with similar promises of major investment, improved care, and debt relief, commissioners ultimately awarded the lease to Sentara.
Once it had the proverbial keys in hand on March 1, 2014, Sentara had to decide: where to begin to turn around the hospital?
“I think the priority is always safety, and patient-centered care, and then you really work the list after that,” Santa Ana said.
More specifically, wait times in the emergency department was an immediate concern, she said. It's the “front door” of the hospital, Santa Ana said, and treats people when their needs are most dire.
Jenny Perry, emergency department team coordinator, recalled that department staff immediately noticed an increase in resources after Sentara took over the hospital. The department had more of the tools needed to do its job, and Sentara was soon emphasizing collaboration between departments, so that patients more quickly got imaging or lab work, or admitted as in-patients, if they needed to be.
More resources, new hires and better processes have reduced wait times to the point that fewer than 1 percent of patients leave the emergency department without being seen, down from a high of 8 percent, Sentara spokeswoman Annya Soucy said.
Better equipping staff was also a concern throughout the hospital, Jaime Carroll, vice president of patient care services, adds. Too often, nurses found themselves without basic supplies, she said.
“That's some simple things, from having floor mats for falls to having bedside tables for every room ... the (intensive care unit) was sharing bedside tables for their rooms when I got here,” she said. “There was one thermometer on a 40-bed unit. ... Obviously we fixed that right away.”
Employee training, morale, and recruitment were also immediate priorities, Santa Ana and Carroll said. Employees needed to know what “patient-centered care” actually meant to Sentara, and how departments were supposed to collaborate on care.
The recent layoffs, financial struggles, and transitioning to new management also weighed on employees five years ago, Santa Ana acknowledged. When she came on board as president in late 2014, she said she emphasized openness, encouraged employees to share ideas, and take initiative. That culture has borne fruit in various areas, including by driving down imaging and treatment times for stroke patients to 21 minutes last year, compared to the national standard of an hour, she said.
That decrease was led by staff, not management, Perry and Santa Ana noted.
Other steps Sentara undertook included granting employee raises and, through the lease process, committing to no immediate layoffs, and providing money to protect retirement plans employees had through Albemarle Hospital.
In another measure of employee satisfaction, Sentara Albemarle’s employee turnover is down to less than 13 percent, better than the national rate for the health care industry, Santa Ana said.
Sentara Albemarle’s ranks of volunteers have also grown since 2014, said Karen Matthews, volunteer coordinator for the hospital. There are almost 100 total hospital volunteers, including teens, who run the gift shop, greet people at the front desk, help with simple parts of patient care and numerous other jobs, she said.
Pasquotank officials and residents also expected Sentara to invest millions of dollars in the hospital and recruit more doctors, keeping care local. Sentara's lease required it invest at least $40 million in the hospital in the first five years.
It's far exceeded that amount, Santa Ana said. Based on community needs, Sentara's investments have included a 3D mammography unit in 2014 — and a second unit early this year — a $1.5 million orthopedic center, a wound healing center including hyperbaric oxygen, and a complete overhaul of the hospital's information technology to implement electronic medical record-keeping.
Michael Chalot, who oversees diagnostic imaging, said imaging alone probably received 25 percent of Sentara's capital investment to date. Apart from mammography devices, the investment has included digital X-rays, magnetic resonance imaging units, a new nuclear medicine camera and new ultrasound machines.
Chalot also agreed that employee morale has steadily climbed since 2014. Sentara has encouraged collaboration and initiative, and employee ideas to improve care often get funded, he said.
Sentara also has recruited 18 physicians, plus other providers, to the area since 2014, according to Soucy. Notably, the lease calls for Sentara to try to recruit several specialists, including a neurologist. Santa Ana said Sentara Albemarle has a nurse practitioner for neurology, with a neurologist available through telemedicine.
In making all those investments over the years, Sentara's mindset has been that, with improved patient care, patients and revenues will return to the hospital. That is happening, Santa Ana said.
Sentara Albemarle has reported improved quality and safety measures for several years and Santa Ana has also reported patient transfers to the hospital grew last year.
Looking ahead, Santa Ana said the hospital will continue to replace old equipment, work to improve perceptions of the hospital, and keep building community partnerships, such as with the Food Bank of the Albemarle.
Asked about specific investments in the next few years, she said Sentara constantly studies patient needs, but a changing industry makes it hard to predict investments beyond two or three years.