South County Hospital: Louis R. Giancola, CEO

by HCE Exchange on March 21, 2011

Growth is an important part of operations at South County Hospital, a 100-bed acute-care facility located in Wakefield, RI. However, according to CEO Louis R. Giancola, growth doesn’t come at the expense of the community.

“One of our challenges is balancing the needs of the community with the needs of the hospital,” Giancola said.  “It’s a fairly homogeneous population in probably one of the fastest growing areas in the state.”

Wakefield is situated 35 miles south of Providence. The hospital, located in a residential community, serves a population of about 100,000, a number that increases during the summer months due to a nearby beach resort. South County traces its roots to a cottage located down the street from the current facility, where the hospital began operation in 1919.  The oldest building on the current hospital grounds dates to 1929 and is where Giancola’s office is located.

South County is part of the South County Hospital Healthcare System, which has a budget of about $100 million per year, he said.  The hospital employs about 900 people, with 625 full-time equivalents and an active medical staff of about 150.  Among those employees are a number of hospitalists.  Giancola said South County instituted a hospitalist program two and one-half years ago and estimates that about 75% of all admissions are handled by a hospitalist.  In the past 10 years, physicians began using hospitalists to care for their patients when they visit emergency rooms or are admitted to the hospital.  Hospitalists, doctors themselves, communicate with the primary care physician while handling a patient’s medical needs during the patient’s hospital stay.

Ancillary Services

In addition to the hospital, the system operates VNS Home Health Services, a home health agency; South County Surgical Supply, a durable medical equipment and surgical supply agency; and South County Quality Care, a private duty nursing organization. The system also operates an urgent-care, off-site facility in North Kingstown, RI, about 12 miles north of South County, in a significant portion of the hospital’s coverage area.

Facility Expansion

During his seven years at South County, Giancola witnessed the construction and renewal of a new emergency department, a new main entrance, a new diagnostic imaging department, and a three-story addition with 60 single rooms.  With this expansion, all patient rooms, including the eight-bed ICU and the seven- room women’s wing, are single-occupancy.

“This was done to create better patient and family accommodations, as well as for infection control,” he said. “As equally important, we created a more attractive environment for our nurses and other clinical staff, particularly as it becomes more difficult to retain and attract skilled personnel.”

Orthopedics

Another construction project at South County resulted in a new orthopedic unit, built around South County Orthopedics, the VNS program and the hospital, in what Giancola calls a non-financial partnership. This venture is designed to consider the care of the total joint patient, he said, with an educational program that all patients undergoing joint replacement procedures must take prior to surgery.

Giancola reported that since instituting this program, total joint surgeries performed at South County increased 60%.  At the current rate, he expects orthopedists at South County will perform nearly 500 total joint surgeries this year, and sees nothing but growth in this market.

“This represents what a community hospital can do in a sophisticated area like this when you marshal all the resources and you work closely with the physicians and the other clinicians to try to organize care around a specific procedure,” he said.

Reimbursement Issues

According to Giancola, Rhode Island historically has very low reimbursements for physicians and hospitals.  Financial issues at South County, in relation to reimbursements, are compounded by an aggressive capital program.  The CEO credits a strong hospital board of directors and community support for helping the hospital in this tough financial climate. He notes that the board in general “was a significant contributor” to the hospital’s $11 million capital campaign, with $2.5 of that coming directly from the board chair.

Another area impacted by low reimbursements, as well as medical liability coverage, is the field of obstetrics and gynecology.  In order to cost-effectively continue offering these services to the community, South County assumed responsibility for the integration of the service and took over the practice.

“We lost some people over time and our births had declined with that, but we’re starting to see that come back,” Giancola said.  “Now we’re developing the whole women’s health service line and thinking about how this practice can be expanded to incorporate other related services, including education and complementary health services.”

Reimbursement also affects South County’s ability to attract new physicians to Rhode Island.  Giancola notes some shortages at different areas, but overall, believes South County is keeping pace with its physician needs by integrating them into the organization financially.  In addition to the obstetricians, South County started its first wholly owned primary care practice, and recently hired an oncologist who, as a hospital employee, is partnering with the private practice oncologist to offer coordinated cancer services in the community.

Staff Culture

South County works hard to create a workplace culture that’s attractive to staff.  The hospital created an employee council as an outlet for staff concerns that are not addressed at the operating level, Giancola said.  Another step toward staff satisfaction was the switch to a merit-based increase system that recognizes performance, as opposed to an across-the-board-system.

“Generally, we’re looking for ways to address the needs of the staff in a more effective way, even in a financially challenged situation,” Giancola said.

Role of Communication

Giancola said communication is vital to maintaining good relations between the hospital and staff.  Bi-weekly payroll memos are included with all payroll stubs or paychecks.  In addition, Giancola visits each department during staff meetings on a quarterly basis.  During these visits, he listens to department concerns while at the same time sharing information about hospital initiatives and challenges.  The hospital also holds town meetings, particularly at the end of the fiscal year, to let the staff know how the company performed that year financially.

In addition, the hospital initiated a management-training program based on feedback from the staff regarding consistency and quality of leadership at the department level.  The hospital is also recruiting some new managers, particularly in nursing, where there was some recent turnover.

“That’s definitely a challenge, across healthcare, and something we’re paying a lot of attention to,” he said. “We can feel the results of inconsistent management or leadership at the departmental level.”

Working Together

At South County, the hospital and physicians are working together to create a strong connection for the future.  Giancola predicts that eventually a significant number of physicians, particularly primary care, will come under the hospital’s wing.

“We think that’s necessary to enhance the bargaining position of the doctors, who are splintered, and don’t have much leverage with third parties,” he said.  “We also think it’s necessary to be able to operate the hospital services more efficiently.  Ultimately, together we can to a better job of enhancing the overall health of the community.”

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