Northwest Hospital (LifeBridge Health): Erik Wexler, President

by HCE Exchange on August 19, 2010

To claim financial stability in economically unstable times is making quite a statement. However, it’s a phrase Northwest Hospital President Erik Wexler makes with confidence. From the time he arrived at this suburban Baltimore 242-bed acute-care hospital, a subsidiary of LifeBridge Health, the organization has built upon its good reputation and good clinical quality, expanding to offer more specialty services. With that, Northwest boasts annual revenues of more than $200 million.

“We’ve been fortunate at Northwest that we’ve been financially stable for a number of years,” Wexler said. “That financial stability has enabled us to weather the storm, although I think we’re still a little early in the storm given health care reform. As time goes on, we’re going to have to be more efficient and we’re looking from the simple to the most complex ways of doing that.  That said, without a doubt, new revenue will trump efficiency as far as performance at Northwest Hospital goes.”

According to Wexler, who has been with Northwest for almost 6 years, simple cost-saving moves include asking employees to turn off lights in rooms that are empty, shutting down computers that are not being used and switching off televisions that aren’t being watched. On the more complex side of things, the hospital is working closely with vendors and renegotiating contracts, putting physician support programs in place that improve throughput and developing new programs that meet community needs and generate margin.

“The idea is to bring our cost structure down and revenue up so that we can flow through our operating margins a replenishment of the operating cash reserves or liquidity that’s been lost by organizations across the country due to the stock market,” he said.

In addition to its medical/surgical beds, the facility includes an intensive care unit, a dedicated 14-bed hospice unit and an in-patient behavioral health unit, as well as an acute-care unit. The hospital has about 1,600 full- and part-time employees.

Specialty Services

Wexler is constantly looking for new ideas for medical specialties to add to Northwest’s general acute care services. One new addition is a hyperbaric oxygen therapy (HBOT) program to augment wound care. Another new program is Northwest’s dedicated in-patient hospice program, established in partnership with Chicago-based Season’s Hospice. This new unit is designed to feel more like home than a hospital setting, Wexler said, providing a peaceful place for terminally ill patients to receive the care they need during the “unfortunate final days of their lives.”

In addition, the Herman and Walter Samuelson Breast Care Center at Northwest Hospital, the organization’s flagship breast treatment entity, was recently relocated to a more expansive spa-like area near the hospital’s main entrance. This expansion coincides with the hiring of new program director Dr. Dawn Johnson Leonard, a fellowship-trained breast surgeon. The program will have a multi-disciplinary approach, whereby a patient can be diagnosed and treated within a short amount of time.

“Often people have a suspicion of breast disease but have to wait weeks,” Wexler said. “Our goal is to have a patient diagnosed and begin treatment within the same week.”

Recruitment through Affiliation

Northwest has survived on a volunteer medical staff that is starting to realize that physicians are leaning into employment-type models or affiliation models with hospitals. Wexler is trying to attract new physicians to Northwest by not only meeting their needs, but also by looking at ways that they can affiliate. Affiliation could mean a full-fledged employment model where the physician becomes an employee of the hospital and continues to work inside or outside the hospital, he said, or it can come in the form of a group affiliation. Regardless of the method, Northwest is creating productivity models where the physician has a lot of independence and control over their day-to-day expenses.

“Our organization is avoiding rigidity by finding a way to create a win-win with the physician group and with the hospital so that they are financially stabilized”, he said.

Technology

Being part of the LifeBridge network, Northwest gets to share technology among all entities within the system – Sinai, Northwest, Levindale Hebrew Geriatric Center and Hospital and Courtland Gardens Nursing & Rehabilitation Center. For several years, Sinai and Northwest have been using computerized provider order entry (CPOE). For a medium-sized hospital like Northwest it has put the facility “ahead of the curve,” when it comes to improving clinical quality and protecting patient safety. When physicians enter pharmacy orders, Wexler said, those orders are checked against all other medications the patient is taking and “red flags” any contraindications, forcing clinicians to validate the medications intend use.

“This system also eliminates the decades-long problem of handwriting,” he said. “That illegibility has gone away with CPOE.”

Northwest has also implemented a patient tracking system that follows patients through their treatment process, from admission through diagnostic testing. Once the patient is discharged, the system signifies that the room needs to be cleaned and prepared for new patients. The system also alerts the staff as to when a room needs maintenance.

“Not only does this system allow the hospital to track patients, but it follows patient productivity and improves throughput,” he said.

Five Objectives

Northwest’s entire staff follows the guidelines established with its five key objectives: Clinical quality, customer service, employee satisfaction, physician satisfaction and financial stability. The management team has always been clear about these objectives, to the point where compensation is tied to achieving those goals.

“That’s part of the value and the beauty of the employees who work here,” Wexler said. “They take what we set out to achieve as serious and part of their accountability.”

Annual goals are established during a two-day off-site executive retreat, Wexler said. They discuss measurements in the five objectives from the prior year, review how the hospital is progressing, and consider areas where personnel may need to improve. This information is then presented to the management team, the medical staff executive committee and the board of directors. Goals for the next fiscal year are based on these recommendations.

“We’ve learned that when people know what the goals are, and you have a limited number of goals that people can get their arms around, you can largely be successful and move your organization to a greater level of accomplishment,” he said.

Two years ago, in addition to the five objectives, the organization decided to establish three-year long-term goals. Two of those are underway and being implemented, one of which is a consumer-based goal and the other is a physician-based goal.

Furthermore, Northwest has established three value-based goals for how employees treat each other: Caring, respect and teamwork. Each value has an expected associated behavior, which is understood by all hospital personnel.  All staff is educated to these values and must sign a commitment form promising to maintain the culture that is what helps to define the hospital.

Balancing Priorities

With a hospital’s often simultaneous initiatives, Wexler noted that it’s important to establish a balance of priorities. Organizations can become too focused on one particular issue, whether that is financial stability or customer service.

“Clinical quality is obviously the most important thing that we do, but regardless, everyone should be focused on all five of our annual objectives,” Wexler said. “Balance in our roles is essential.”

Northwest also has the responsibility of staying abreast of healthcare developments across the country, looking for innovations that could be incorporated into the hospital’s operations. He finds medical publications to be good resources for picking up pointers, as well as speaking with colleagues, becoming involved in professional associations and staying in contact with the hospital’s own front-line staff.

“That allows us to not only keep balance but make sure that the organization is addressing the needs of all people,” he said.

Northwest’s stature in the community is due in part to the passion of its front-line staff and leadership toward maintaining clinical quality and excellence. Wexler believes that passion is part of Northwest’s DNA and one of the reasons for its success.

-by Kathy Knaub-Hardy

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