Interim LSU Public Hospital: Dr. Juzar Ali, Medical Director

by HCE Exchange on November 1, 2010

The second oldest public hospital in the United States is in New Orleans, Louisiana. In the first 100 colorful years of its history, Charity Hospital existed in five different locations and was battered over the years by storms and fire. The sixth facility was built in 1939 and housed the hospital until it became a victim of Hurricane Katrina in August 2005. Charity Hospital and University Hospital were part of the Medical Center of Louisiana at New Orleans.  Because of severe storm damage, Charity Hospital will not reopen.  At that time, the Medical Center of Louisiana at New Orleans was part of  the LSU Health Care Services Division. In November of 2006, University Hospital reopened as the Interim LSU Public Hospital (ILH) to provide comprehensive healthcare services.

ILH has a tertiary care, multi-disciplinary, Level 1 “Spirit of Charity” trauma center with a very busy Emergency Department.   ILH is affiliated with two medical schools (one is at the LSU Health Sciences Center; the other is at Tulane University). The 300-bed hospital runs an occupancy rate of about 80 percent. Its ambulatory clinics, which cater to the needs of the community with 16000 patient visits per month, are located in nearby buildings, and the hospital also has a well connected network of community clinics. The two medical schools provide approximately 800 medical staff . There are also community physicians on staff with limited privileges who assist those to refer patients to the hospital system and ensure community care follow up.

“We have about 300 house officers from both schools who rotate through this institution and as part of their graduate medical program.  Their training  ranges from primary care to specialty and sub-specialty medical and surgical fields,”  says Dr. Juzar Ali, Medical Director of ILH .  Ali’s role is to be the liaison and coordinator for the faculty and house staff in organizing and operating clinical services at the hospital. He is also a member of the administrative council that runs the day to day operations of the hospital.

Recovery from the Storm

Since November 2008, when Ali joined the hospital team, he has focused on the recovery work begun by his predecessors in further streamlining of the operational function of the hospital from the clinical perspective. “Multiple clinical  programs  have been restarted, and improved  processes that enhance patient care, emphasize patient satisfaction, facilitate access to care,  ensure continuity of care and improve throughput  have been established. We have now reached the stage where we are a little bit more settled, and look forward to the future, ” says Ali.

Prior to taking up the position of medical director, Ali was a full-time Professor of Medicine and a clinical educator at the LSU HSC School of Medicine in the section of Pulmonary /Critical Care Medicine. He continues this role in a limited fashion at ILH. “When I took up this position, I asked myself, ‘Why?’” he says.

“The answer involves moving this institution to a new academic medical center, which we hope to build by 2014. In this transition period, while we  build a new brick and mortar building, we need to get ready for that new facility by enhancing our culture of patient care and streamlining our infrastructure.”

Ali also looks to transform the years old vision of Charity Hospital to one of a modern and true academic medical center. “The clinical excellence of our medical staff is world class,” he says. “The professional expertise and the cutting-edge research at the core and translational levels are top notch.  I want to bring the active engagement of the faculty and house staff into the working of the hospital and to truly take it, not only from bench to bedside, but also from “gown to town.” That is what my vision is.  Further, no matter what academic medical center we have, this cannot work in isolation. We have to involve the community with its participation and service to its needs.”

Strengths and Limitations of the Institution

The emergency room department, level one trauma center, specialty surgery and disease management programs, and intensive care units are all on Ali’s list of strengths of the institution. “We are not limited to business as a safety net hospital alone, but we attract patients from all over the community and our sister hospitals in the state network,” he says.

It is the physical structure itself that is a weakness for ILH at the moment. The working facility is old, and it has space limitations. “It doesn’t mean that we are not improving on things, but we are focusing more on maintaining what we have and on concentrating on improving  the processes of delivery of care  rather than only capital outlay improvement,” says Ali.

Budgetary constraints have forced them to cut staff in the past 16 to18 months, mainly in the realm of operational and supply costs and by reducing the full-time-employee to bed ratio. “If not today, maybe in the coming years we will be able to look at the possibility of expansion of certain programs,” says Ali.

Through the difficulties, Ali holds two areas above compromise. “We have tried not to compromise on how the medical and nursing staff provides services that relate to patient care and achieving national standards. It’s a balancing act, in this day and age of fiscal constraints,” Ali says.

“The template we are working with is a very unique one, from the point of view of being a dual focus.  In this system, at one end we have the challenges of amalgamating the teaching, training and academic mission of the medical schools and merging it with the mission of patient care and healthcare delivery to a community. This poses business challenges with operational budgetary constraints. It’s also providing , what you can see historically,  as a change of focus, from where it was previously considered only a safety net public hospital  to a more expanded focus of value-oriented care,” says Ali. “We are not where we should be, but the new academic medical center is what we look forward to becoming in the next five years, and our journey has begun.” Ali concludes.

-by T.M. Simmons

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