Gilbert Hospital: Dr. Tim Johns, Founder and Medical Director

by HCE Exchange on April 28, 2011

In many health systems, administrators and boards — made up of business degrees and former clinical professionals — make the business and bedside decisions for staff and patients. But Tim Johns, MD, an emergency medicine physician, decided that system wasn’t working and set out on his own to begin a hospital run by the medical staff.

“At previous hospitals, we had highly educated doctors and nurses who knew what needed to be done at the bedside, but they weren’t given the proper voice,” he said. So he started Gilbert Hospital, a 25-bed acute care general hospital in the small town of Gilbert, Arizona.

“We don’t want an MBA approach to healthcare; we want a healthcare approach to healthcare,” he said. “At Gilbert Hospital, the management team gets their direction from those providing care.”

Challenging the status quo

Dr. Johns worked for a larger hospital, working his way up the ladder to the Board of Trustees level. But he became more and more frustrated with the administrative procedures and the way departments operated as silos, even though, as he said, the emergency room was intertwined with 13 other departments.

“We tried to make each department as efficient as possible, but if the emergency room couldn’t interact efficiently with even one other department, the whole system began to break down,” he said.

Dr. Johns finally decided to embark on his own to establish a small, community hospital focused on providing emergency care. Although he was told it wasn’t possible, Dr. Johns opened Gilbert with only two inpatient beds, and in the past five years has expanded to 25. The hospital continues to grow with the community and is about to break ground on space for an additional 40 beds and increased ICU capacity.

He takes a unique approach to building hospitals as well. Rather than looking for large communities that can support a 400-bed hospital, Dr. Johns looks to open hospitals in smaller communities with a need for emergency care close to home.

A new facility in Florence, Arizona, is under construction and about halfway through completion. This hospital is in an area with 13 prisons, housing about 19,000 prisoners. The new facility will have a lock-down wing to provide separate care for prisoners away from the main hospital population.

Funding always remains a challenge, but Dr. Johns is confident that if the management team puts patient care first, the money will follow.

“Funding hospitals like this is difficult,” he said. “Our main service line is emergency services, and emergency rooms lose money. But we will continue to do the right thing, and the money will catch up.”

Taking a medical staff-led approach to providing care

At Gilbert Hospital, the medical staff are empowered to make change and suggest ideas. The management staff is required to support the medical staff in their needs. For example, if a physician needs a new piece of equipment to provide care, rather than requiring him to present a return on investment to multiple committees, Gilbert Hospital leadership will do everything within its power to ensure the physician gets the equipment he needs.

In addition, when many emergency rooms have one nurse assigned to four patients, Gilbert takes a team approach at the bedside.

“Patients are seen by a team consisting of a registered nurse, a paramedic, and a technician,” Dr. Johns said. “Each team takes care of six beds. This approach has the same dollar per hour cost as one nurse seeing four patients, but the nurse has time to do what she’s trained to do — give medications, assess reactions to those medications, do procedures.”

Dr. Johns said the hospital has seen tremendous success through this unique approach. He said patient satisfaction scores are “through the roof.” From a patient perspective, the team approach makes them feel valued and as though they are receiving extra care.

Plus, nurses feel valued. The turnover rate at Gilbert is under 3 percent, as opposed to 24 percent for the state of Arizona.

The team approach also allows nurses the support they need and time to pay attention to quality measures. Dr. Johns said the hospital’s quality standards according to the CMS indicators are exceptional.

Through this experience, Dr. Johns said he would encourage physicians to become more involved in the business of providing healthcare.

“Doctors used to run hospitals,” he said. “The control of medicine needs to be back in the hands of providers. Nobody knows what’s better for patients than those providing the care at the bedside.

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