St. Rita’s Medical Center: Jim Reber, CEO

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Looking at the changing healthcare landscape, one shift in many communities is toward providing more community health management services. As Jim Reber, chief executive officer of St. Rita’s Medical Center puts it, in the future the hospital may become more of a “genuine health system with health offerings rather than illness offerings.”

St. Rita’s Medical Center, in west-central Ohio, is making an organizational shift toward health offerings through community partnerships and employee initiatives.

“We are working to establish community-wide protocols, evidence-based pathways in place for five major chronic diseases,” Reber said.

These five major chronic diseases are hypertension, coronary-artery disease, congestive heart failure, joint degeneration, and obesity.

“We are also working with employees to see what motivates change, particularly in the cafeteria,” he added.

One initiative raised awareness of the nutritional value of meal choices through a color-coding system and by posting the calories in each option. Reber said the sale of french fries declined 10 percent in just 30 days. Furthermore, all vending machines will have healthy choices.

With a large set of the nation’s population uninsured or underinsured and a declining general state of health compounded by the country facing a physician shortage, the need for improved community health is paramount. Given these factors, Reber said it’s possible “we may not have the resources to provide care at the scope and level we historically have.”

Involving patients in care

One area St. Rita’s has been working on is its community population health management, specifically for diabetes. The organization is working to create a shift from looking at a diabetic admission not as one single admission, but as a person that needs to be managed across the health system. St. Rita’s has specialists and primary-care providers working together throughout the community to help prevent those admissions.

Historically, patients have been seen at [somewhat] infrequent intervals by their primary-care physicians or during a hospital admission.  By having a process where patients are kept in closer contact with their health team, the teaching and education becomes a continuous process and patients can be helped much sooner, thus avoiding readmissions.  Perhaps the most critical part of managing a patient with diabetes (or any chronic illness) is understanding their lifestyle and the best approach in helping them achieve their goals.

“With declining reimbursement rates, there will be a need to improve patient health, patient involvement, and compliance,” Reber said. “The next five years will call us to be better at managing diabetes, asthma, heart disease, and other chronic conditions long before the patient is admitted to the hospital.

“Our employed physician offices are using an electronic system that contains a portal for patients to access their individual health records.  At that site, they can view test results, request appointments, and overall, be more involved in their health.”

Additionally, Reber said, an iPhone app is in final testing. Through this and other vehicles, he hopes to further facilitate the activation of patients and their increased involvement in care across the St. Rita’s system.

Maintaining St. Rita’s economic health

As it focuses on the health of the community it serves, St. Rita’s is also making strides to improve the economic health of the organization, ensuring its ability to continue providing high-quality care to its patients.

St. Rita’s is a health-delivery system of about 13 entities and partnerships and is part of Catholic Healthcare Partners. It serves a 10-county region in mostly rural Ohio, about two hours from major metropolitan areas. The system has about 3900 employees and $400 million in annual revenue. Reber said the hospital has seen market-share gains consistently for the past 10 years and has maintained an alliance with five local hospital for 15 years to share resources.

In a rural region, recruiting physicians and specialists is often difficult. St. Rita’s has a physician-employment model that has allowed it to recruit specialists that are often hard to attract.  However, the organization believes that specialists want to congregate in metropolitan areas.

“Recognizing this need and related market conditions complements our recruiting effort,” Reber said. “We think physicians want to assemble in more stable call groups, leverage practice costs, and build collaborative relationships with like and accretive specialties.  Once a critical mass of specialists is reached in the metro area, it becomes more feasible for the group to then hub-and-spoke out to rural areas and thereby meet patient demand in their local market and at their local hospital.”

Improvement through lean

To improve safety and efficiency, St. Rita’s has implemented lean techniques, including walk-arounds and a reporting model where employees can go on their computer and report anything that happened that they didn’t think was right. Reber said every event reported is addressed and resolved within two weeks. The organization also plans to implement a full install of the Epic suite of products.

“On a cost side, we use lean techniques to help the organization, but we never allow that to undermine patient or employee satisfaction,” Reber said. “We are looking at a greater level of accountability and ways to eliminate waste. We think Epic will help. Patients will be able to go online and pick their own appointments, look at labs online, and other tools that empower patients.”

With any initiative, Reber said, the focus of St. Rita’s is always on doing what is best for the patients and community it serves. As CEO for 23 years, Reber is personally invested in improving the lives of the organization’s surrounding community.

He also advises that the key to a successful healthcare organization is to be driven by evidence, not politics.  All too often, the loudest voice or the highest-ranking voice can dominate decision-making.

“We believe that the best idea which improves the lives of the people in west-central Ohio should always be chosen.”

-by Patricia Chaney

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