Randolph Medical Center: Tim Harlin, CEO

by HCE Exchange on August 19, 2010

Tucked away in the heart of the South in Eastern Alabama, right along the border with Georgia sits a small 25-bed hospital, Randolph Medical Center. It’s a Medicare designated critical access hospital and that makes it a lifeline for its community. But just because it’s critically needed, doesn’t mean that Randolph has been immune to struggle. Quite to the contrary, it has been an uphill journey for the organization, which has seen both public and private owners. But for the past few years, with help of public ownership and funding, in addition to a new leadership team led by Tim Harlin, the small-town hospital has been proving that good care can come from a small hospital.

First Line of Care for Thousands of Residents

To understand the importance of Randolph to the Alabama community, it’s important first to understand the demographics and needs of this Southern community. Randolph is one of only three critical access hospitals in the state and the closest alternative hospital, East Alabama Medical Center is some 45 miles away from the Roanoke community that Randolph serves. The county consists of about 20,000 residents and as with most Southern rural hospitals, Randolph cares for a wide range of health issues. “We see just about every health issue in the nation, including cardiovascular disease, diabetes, obesity, hypertension but we have them in great numbers and at, rates that are higher than national averages.”

“We’re sort of an outpost, we run a 24/7 emergency room staffed with MDs,” explains Harlin. “We don’t use mid-level nurse-practitioners, so there’s always a physician in the house. Anything you can imagine, we see, everything from overdoses, gun shot victims and motor vehicle accidents to sore throats and the sniffles.” Since January of 2008, in addition to the 25-general acute beds, Randolph also houses a 10-bed unit for adult psychiatric patients. But, because of the Medicare critical access designation, the hospital’s bed capacity is limited. “ We do a lot of what we call stabilize and transfer so if someone comes in and has major trauma or chest pain, we’ll stabilize them here and put them on an ambulance or on a helicopter to a more appropriate setting, either a trauma center in Birmingham or the cath lab at East Alabama.”

Getting Noticed for Improvements

Recently Randolph received a million dollar grant from the Department of Health and Human Services. Although this was extremely welcome news, it probably didn’t come as a huge surprise to the organization. That’s because Randolph has become very successful in attaining grants and with this grant their funds obtained over the past few years totals around $2 million.  The Health and Human Service grant is called a Health Information Technology (HIT) grant and it was awarded in conjunction with the Alabama Department of Public Health, which made Randolph a sub-grantee.

“We pitched it and focused on cardiology and cardiovascular disease and what made our applications stand out were things we already were doing in this area.” Harlin cites the addition of a new state-of-the-art CT scanner as playing a major role in this initiative. “We had a catastrophic failure of our old CT scanner and when that failed we chose to replace it with a 64-slice scanner and are now able offer 3D heart scans that can rule out the need for a catheterization. We were the first critical access hospital in the country to offer that, so I think we were able to demonstrate to everyone that we were on the forefront of innovative care.”

Using Broadlane, a group purchasing organization, the hospital was able to become part of a group buy program that allowed it to commit to the purchase but save some $200,000. “Using Broadlane we were able to vet those vendors in a technical way we wouldn’t have been able to on our own. Broadlane insists on contractually holding the vendors to very robust contracts that we wouldn’t have had the leverage to get if we weren’t part of the group buy plan.”

A Revolutionary Collaboration

But if Randolph’s investment in a high-tech CT scanner was unprecedented, what they proposed to use this grant money for was even more revolutionary. Randolph proposed to implement electronic record keeping and change from its previous paper system. Nothing out of the ordinary there of course, but what Randolph proposed to do with those records was a long-shot. “Once we got our electronic record system in place and up to speed we proposed to then allow doctors at East Alabama Hospital to log into our system, so they could check on patients we sent them. In turn, we would be able to tap into their system to learn about what they had done in treating patients.”

But taking two organizations that were not affiliated with each other and had different by-laws and patient privacy policies meant much negotiation and compromising needed to be done. “We don’t compete with each other because we are on completely different scales, but at the same time, we aren’t affiliated, so there’s that air of suspicion. You don’t want to open up your system to someone else, so we all had reasonable suspicions. But everyone realized that it was worth the effort because it’s all about giving doctors the information they need to give better care.”

Harlin says it took a lot of mediating, but once the legal, regulatory and procedural issues were taken care of, it was just a matter of simply putting in the proper programming safeguards, using Healthland as electronic health record provider. “We worked hard and figured it out so it was only a matter of some custom programming so we could each only see what we needed to see. Patients give written permission to share the information between doctors and hospitals. Everything they know about the patient we’ll know, but only physicians can log into the system.”

The Right Combination of Conservative Spending and Continued Growth

Although capital is scarce at Randolph, like it is for most medical centers in the recession economy, Harlin says that he has made a concerted effort to initiate investments to make Randolph a relevant and positive force in the community. “Before I got here they tried to cut to the bone and hang on to survive. I got here in 2005, coinciding with the city leasing Randolph from the county and I told a brand new board that was just formed, ‘we won’t shrink our way to success, if we don’t gain the trust of the community and gain the trust of the patients and if we don’t provide care that is relevant to them we might as well just lock the doors.’ Just hanging on isn’t good enough.”

Harlin says the organization has begun to look at smart ways to grow, such as re-opening operating rooms for outpatient surgeries, investing in the 64-slice CT scanner, adding more staff in specialties and primary care and working on improving patient satisfaction numbers. “We’ve added new equipment where we needed it with the focus on the brand. The organization’s brand is either spiraling down or spiraling up, it’s rarely standing still. We want people to leave here thinking, ‘wow look at what they are doing here!’ and I think it’s working. You have to compete and we have to dare to be great. I like to say, ‘let’s do something completely uncharacteristic of a hospital of our size and the CT scanner is a symbol of that. We want people to know that we are passionate about rural health care, we are after all taking care of the people that live down the street from us.”

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