MLKCH Opens with a Fresh Culture and a Fresh Start

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In 2007, the historic King Drew Medical Center in Los Angeles, Calif., closed, after years of persistent and unresolvable quality and patient safety problems.

King Drew had originally been founded by the county of Los Angeles following the Watts Riots as a public hospital. It served a low-income, medically underserved community of 1.3 million people.

When it closed, the need for a new hospital to replace it was immediately apparent to county and state leaders. Los Angeles County and the University of California entered into an agreement to support the development of a new private hospital on campus. As part of that agreement, they then jointly selected a governing board for the hospital.

Elaine Batchlor, MD, MPH, chief executive officer, was selected for the governing board in August 2010 and eventually appointed CEO. On May 14, 2015, Martin Luther King Jr. Community Hospital officially opened.

Dr. Batchlor described this hospital as being different from King Drew.

“It’s now a private, not-for-profit, safety-net hospital,” she said.

Starting from scratch

Dr. Batchlor said starting a hospital from scratch is exciting. It may also be one of the ultimate career challenges. MLKCH’s board made a point of laying the foundation for the organization before they even had a building.

“I recognized the risks involved, but the people who came together to start the hospital had a vision of what they felt it could be and what they wanted it to be,” she said. “That vision was exciting and meaningful. We felt that we were coming together to do something important for a community that really needed it.”

It also fit Dr. Batchlor’s background as a safety-net provider.

“Taking on this project was a continuation of the population-health and safety-net focus in my career and part of my identity as a physician.”

When Dr. Batchlor says they started from scratch, she means it. She and her team had nothing when they began.

“We built this organization as a start-up,” she said. “That means that we started with things like buying insurance establishing our nonprofit status, hiring core staff, and bringing in people with expertise in different areas to help create the infrastructure. I was employee number one. We now have a staff of over 680 people.”

Opening in a challenging marketplace

Early on in the process, the governance board conducted a community-needs assessment to inform planning. One key finding was a shortage of 700 primary-care physicians and 1,000 specialists within the community.

“It’s a market that is challenging from a business perspective because it is a low-income community with Medicaid as the dominant payer, and unfortunately, despite the expansion of insurance under the Affordable Care Act, there continue to be residents who are uninsured and aren’t eligible for public programs because of their immigration status,” Dr. Batchlor said.

The community-needs assessment also revealed that the population was younger than other parts of L.A., and the women in the community were having a high volume of babies. The board placed top priority on expanding the hospital’s OB program to both meet the needs of families and to maintain high-quality OB services.

A fundraising foundation was established and its first project was to raise money to expand the OB program before the hospital opened. The drive was successful and $8 million was brought in, basically doubling the number of deliveries MLKCH could do.

Dr. Batchlor points out that they did this even though more deliveries doesn’t necessarily result in a better bottom line. From the beginning, the board was determined to preface every organizational decision with the question, “What is best for the community and for our patients?” she said.

In opening this hospital, Dr. Batchlor also said she was reminded of how essential good project management is.

“I’m not sure that’s something a doctor would ordinarily know, but you really need to have good project management and good contingency planning. You have to be flexible and creative at solving problems.”

Furthermore, she learned to hold out for the best hires, to have the confidence to take risks, and to make bold, daring calls.

Establishing a fresh culture

“We had the advantage of starting from the beginning and being able to establish the culture that we wanted for the hospital,” Dr. Batchlor said. “We were thoughtful about what that culture should be, and we designed our policies and infrastructure to support that culture. More importantly, we hired staff who were in alignment with that culture.”

Employee candidates are evaluated not only for their technical qualifications, but also for their fit and alignment with the organization’s mission. The hospital already has prevention and wellness programs in place, and care coordination tops the list as they work with outpatient providers to strengthen the outpatient network of care.

“We are leading development of an integrated, coordinated system of care that starts before people need us, with prevention and wellness, and includes all aspects of care that people need in the arc of their health life,” she said.

Martin Luther King Jr. Community Hospital was designed as an all-digital hospital. When it opened, there were no paper records. The electronic health records platform was already in place, as was its telemedicine program, a patient interactive system in each room, and a patient and physician portal for the EHR.

“We’re designing innovative approaches into our hospital,” Dr. Batchlor said. “We’ve identified best practices and evidence-based protocols that are integrated into our EHR so the physicians who practice here have an easy path to doing the right thing.

“We have the opportunity to create a hospital that is appropriate for the moment that we’re in right now. In creating a new organization, we’re building for healthcare’s present and its future.”

by Pete Fernbaugh

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