10

MANEUVERING THE NEW HEALTHCARE

The Tower

Now that the Tower was finally complete, people were proud of the gleaming new 10-story addition to Eastlake General Hospital. It stood out like a beacon on the horizon, welcoming everyone who approached the hospital campus. It also doubled the hospital’s square footage, adding desperately needed hospital beds. So it seemed almost counterintuitive to Emily Fisher that now that the building was complete—and they no longer had to deal with the daily dust, rumble, vibration, or general disruption of a construction zone—she had begun hearing complaints from colleagues.

“Well, now that it’s finished, we have patients in the Tower and have to go up there several times a day,” Tony Worley, one of the charge nurses, told her. “It’s not that we didn’t know this would happen, but reality is a …”

“Don’t say it,” laughed Emily. “It’s too early.”

Emily was a patient care representative in the hospital’s Wellness Institute, which had been her dream job when she started more than five years ago. With an advanced degree in public health, she wasn’t a nurse like many of her hospital colleagues, but she believed she understood both their point of view and their pain. Tony wasn’t the first nurse to point out that the Tower had added five miles and an extra hour to his daily rounds.

“I like the exercise,” he would say, “and I don’t have family waiting at home. But, what about the others?”

Emily knew whom he meant—the floor nurses who’d earlier taken in stride the move from eight- to 12-hour shifts, which were now stretching easily to 13 hours or longer. Some of those nurses were among the hospital’s most experienced staff, and had planned to retire years ago before the recession changed their plans.

Eastlake General Hospital

Eastlake General Hospital, founded in the 1890s, was the city of Eastlake’s first hospital. Its radiology department was one of the first such accredited departments in the country, and it has become known for advancements in geriatric medicine, hospice and palliative care, women’s health, orthopedics, and cardiology. The 400-bed hospital remains top ranked in its region, a provider of compassionate healthcare from its original downtown location. At a cost of $300 million, the recently completed 10-story tower had added 70 private beds and five surgery theaters.

“Where’s everybody going?”

On the other side of town, the new University Family Health Center (UFHC) opened on the old City Hospital grounds. It wasn’t uncommon to hear of another nurse who’d left Eastlake to work there. Emily drove past it daily, watching as it grew from green space after the hospital was bulldozed to a brand-new facility. UFHC was part of the ambitious University Health Clinic, which had expanded its reach over the last decade adding locations throughout the region and boasting a renewed mission of patient care. It was also one of the first hospitals to create a new office of patient experience, which was tasked with actively using patient satisfaction surveys and technology.

The Wellness Institute, despite its name, wasn’t on the same level. Dr. Hans Jonas, the institute’s director and Emily’s boss, meant well; he was an earnest practitioner, but not dynamic. He was older, but the problem wasn’t his age, it was his personality. To put it bluntly, she wondered whether his temperament was suited for healthcare at all. He’d been reprimanded for his dealings with nurses and was often sharp with any staff on the hospital floor. He had been associated with the hospital his entire career, and when the administration transitioned from medical specialties to institutes and departments, Dr. Jonas was made director of the Wellness Institute. However, as the last one created, it almost seemed like an afterthought—and many wondered if it was a means to sideline Dr. Jonas or force him out.

The Institute was one of the hospital’s smaller departments in terms of staff and budget, but Emily thought it had great potential for a wider reach in preventive care. Its full-time staff consisted of Dr. Jonas, a physiotherapist, a physician’s assistant, a nurse practitioner, and Emily; it also contracted with private practitioners throughout the city who led a variety of classes and courses across the wellness spectrum. But Emily thought that not focusing its presence among patients during their hospital stay and after was a missed opportunity. She believed the Institute could have greater impact than it had among people at a critical healing time of their lives. She and Dr. Jonas had long had discussions about this, but they’d led nowhere, as far as she was concerned. Emily ultimately decided that as long as Dr. Jonas directed the Wellness Institute, its mission wouldn’t change.

“Where’s everybody going?” Dr. Jonas asked suddenly. It was the end of the work week, the offices were empty, and Tony had swung by at the end of his floor shift.

“Out for a drink. Wanna come?” Tony ventured. Emily glared at him.

Dr. Jonas looked at him, confused. “No, I mean … not that. Where’s everybody on your floor going? It looks like you’ve lost nurses.”

“Well, that’s true,” replied Tony. “Two have gone to that new family health center.”

“How about you?”

“I don’t mind my shifts, so I don’t know…. But it’s stressful losing people, for sure.”

“So that’s why people leave, because of their shifts?” Dr. Jonas asked.

“There’s other reasons, too, but there’s always a shiny new car.”

Dr. Jonas looked at Tony blankly, and glanced at Emily, who stood in the doorway with her coat on, ready to go.

“The new place is pretty appealing,” she said by way of explanation. “They’re getting the hours they want, better pay, and it’s very patient driven.”

“Hmm, sounds like you’ve given that some thought,” said Dr. Jonas.

“Disruption is good?”

When Emily was offered the new position of assistant director for patient care at UFHC, she waited a week before telling anyone at the hospital.

“Maybe you don’t want it,” Tony said matter of factly. “Maybe you’re not ready to make that kind of move.”

“No, I think I’m ready,” she said. “This is the kind of position I was hoping we’d have here at the hospital by now. It just hasn’t turned out that way.”

So Emily was surprised when Dr. Jonas made her a counteroffer, asking her to create the kind of team that she thought the Wellness Institute needed.

“That would take money,” she said.

“Which you wouldn’t have, you know that,” he said. “Budgets are tight, but you’d have my full support, which if you think about it, is still worth something.”

“Look,” Emily said, facing her boss, “Everything I read says disruption is coming to us here at the hospital, to healthcare, and that it’s a good thing. And I say, really? Change is difficult. I think that I can have more impact in primary care because that’s where the people are.”

“Aren’t people everywhere?” Dr. Jonas asked. “Try and figure out those things you’ve told me about. Why do people miss appointments? What about offering same-day appointments? Can you figure out a way to develop some teams across disciplines and get some answers? It would all be voluntary, of course, but I’ll be behind you if you get results. What if it had effects in the hospital as well as beyond, wouldn’t that be something?”

Emily had to admit that Dr. Jonas had given her something to think about. Should she accept his challenge, or leave for UFHC and a promotion?