The Business of Quality Health Care

“To find joy in work,” wrote American novelist Pearl S. Buck, “is to discover the fountain of youth."

While Huntington Hospital’s President and Chief Executive Officer, Steve Ralph, is as impatient as the rest of us for a medical discovery that will reverse the aging process – or at least slow it down – there’s no denying that passion for one’s career is an exciting and viable contributor to staying young.

Did I mention I like what I’m doing?” he remarks several times during our chat. His enthusiasm resonates in every reply, starting with the reasons that brought him to the helm of one of Southern California’s most respected hospitals.

I’m not a native Californian,” he begins, indicating the Vermont landscapes that adorn his office. “For my whole career - I’ve been in health care since 1973 - you could say I steadily headed west. It started with undergraduate school at the University of Vermont, graduate school and an MBA in Health Management at the University of Minnesota, and then 6 years at University Hospital in Tucson.”

His move to Los Angeles in 1980 found him working for the California Hospital Medical Center, a downtown Los Angeles facility. Four years later, he moved to Huntington, first as its Chief Operating Officer and, for the past 11 years, as President and CEO. He proudly relates he’s been married for 32 years, has 2 children who went through San Marino schools, and possesses no shortage of strong community ties.

People who run hospitals and work in them,” he observes, “have a social mission that makes for one of the intangible benefits of the job. I mention this because even though my degrees are in business management and finance, my passion for hospitals like Huntington is that I really believe they make a difference, not just in the lives of the patients they serve but in the life and vitality of the communities around them.”

Running this hospital,” he illustrates, “is like running a big business. In fact, it’s probably the second or third largest employer in the region. We have 3,000 employees and an annual operating budget of close to $400 million. You don’t often stop to think about it that way but the economic activity generated by this hospital is significant. Our product, if you will, is providing healthcare services to people who need us. If they’re satisfied and grateful with what we’re able to do, then we are successful. We can say with complete honesty that it’s not about making money; it’s about making positive changes that will help people live better and longer.”

This was a commitment, he goes on, that was founded by a group of Pasadena citizens 115 years ago. “When people ask me who owns Huntington, my answer is ‘the community.’ My job, my stewardship of this enterprise, is to make sure we not only continue the legacy given to us but improve upon it as well.”

Certainly the external signs of Huntington’s growth have been in evidence since the mid-1980s when the hospital’s governing board, medical staff leadership and management determined that new facilities were needed. He points out the window to one of the original structures erected in 1922. “The operating rooms, radiology and lots of inpatient beds were in buildings dating from 1938 and on into the 50s and 60s. The driving intent behind the West Tower going up on California – as well as earlier construction phases in the 90s - was to replace the older portions of the hospital.”

One of the challenging aspects of the expansion process, he reflects, involved putting four new floors on top of an existing three during phase two of construction. “What’s interesting is that the lower floors were occupied the entire time, so you had surgeries going on and people coming in and out of emergency while there were huge cranes and steelworkers working directly above!” It turned out to be one of the largest over-builds for a hospital in California.

Retrofitting, of course, is a prevalent concern in the California hospital construction industry. Ralph cites that following the 1994 Northridge earthquake, Huntington emerged with minimal damage– “even its original buildings that weren’t built to be seismically compliant.”

The timing of legislation which subsequently required hospitals to conform to rigorous new seismic standards was timely, in Ralph’s view, since much of the replacement process was already in progress. “From a building perspective, Huntington is positioned very well to meet the state seismic requirements in providing a safe environment that will be in place for many years to come.”

Occupancy of the West Tower is slated for early 2008. “The new building will contain 128 new private patient rooms, a new laboratory, food service, community rooms and pharmacy. It’s also important for readers to understand that all of the East and West Towers are basically a replacement facility – we’re not really becoming a bigger hospital! We’re currently licensed for 522 beds and that number will stay relatively the same when we take occupancy.”

He reveals a significant amount of the construction funding comes from community donations and grateful patients. “I think this outpouring of support speaks to our reputation of providing excellent clinical care, effective provider/consumer relationships, things people expect from us. That, in turn, all gets back to the excellent people who work here and the quality of expertise we’re brought together in terms of doctors, nurses, technicians and people who really care about doing a great job. We work hard to maintain that. In many ways, we are a regional medical center offering programs such as San Gabriel Valley’s only trauma center, only pediatric intensive care unit, only Level III neonatal intensive care unit, and a large medical teaching program. I guess you would call us a cross between a great community hospital and an academic medical center.” Because of this unique position, Ralph explains Huntington is able to attract and recruit an ongoing body of well-respected healthcare professionals.

Our conversation turns to a 2002 report released by the Health Resources and Services Administration which indicated that the nursing shortage in the U.S. will deepen over the next two decades. The reason? Increasing numbers of nurses are retiring while too few are entering the profession. This has been coupled with subsequent studies that state 75 percent of RNs see this shortage as a catalyst for increased job stress and decreased time that can be spent on patient care. Further, an April 2006 report by the American Hospital Association revealed that 49 percent of hospital CEOs had more difficulty recruiting RNs in 2005 than in 2004. I ask if these sobering statistics have affected staffing levels at Huntington.

Well, I think it all gets back to providing the right professional environment. Everyone, particularly nurses, have to know and feel they’re a vital part of what we do and have an input on the workings of this hospital. We currently have about 1,000 registered nurses who work here at Huntington and – as a matter of fact – we just had a breakfast this morning to welcome 35 new nursing graduates. What I think attracts them to Huntington is an environment that has the resources and professional support where they can best accomplish what they’ve been educated to do. Having a collegial relationship with our medical staff is another important aspect of why they want to come here and why they want to stay for the long term. Clinical folks like being part of the decision-making because they understand what it takes to be able to provide the best services to the patients who will be under their care. For instance, as we proceed to enlarge and improve our emergency department, a team of people who work in that department and have the best grasp of what kind of facilities are needed to make things work efficiently are actually developing the design.”

Employee surveys are also conducted on a regular basis. “What the feedback shows is that most everyone seems to enjoy being part of this organization. Do we have challenges? Yes. But we address them in a proactive, engaging manner.”

Moving forward in the 21st century has further required Huntington to acknowledge that the reality of an aging American workforce is reshaping the delivery of today’s health and wellness programs.

Ralph heaves a sigh. “We’re all getting older, aren’t we?” he says, making note of the fact that members of the baby boomer generation are now entering their 60s.

There’s a lot of people who are going to need health care and, as we know, the older we get the more hospital, physician and outpatient services we use. To address that, one of the things we’ll be building on the corner of California and Fair Oaks in partnership with a healthcare-focused developer is the development of an outpatient center: medical offices, outpatient imaging, outpatient surgery and our outpatient cancer programs with an eye toward making these services more convenient and accessible.”

That we are now living longer than our ancestors is an issue not lost on Huntington staff. “Besides lifestyle changes, much of this longer life expectancy is because of the advances we’ve made in medical technology, the development of new drugs, and even the proliferation of replacement parts. What happens, of course, as we age is that many of us are going to get some chronic disease. The reason we didn’t hear that much about it in the past is that people tended to have an acute problem like a heart attack and die. Today, a lot of people either don’t have the heart attack in the first place because they’re taking better care of themselves and/or they have the attack but get saved by surgery and/or medication and go on living for another 20 or 30 years. From a medical planning perspective, it’s a challenge for us to think about how we’ll respond to this changing and probably more demanding healthcare picture.”

Huntington, he praises, has always been an early adopter of new technology and new ways of doing things. This, he says, must continue and stay in concert with the ethnically diverse demographics of our region.

How hospitals operate will be impacted by their sensitivity to the public’s mindset toward health and healing. The practices of Western medicine, for example, contrasted to Eastern philosophies regarding prevention, treatment and hospitalization make for an interesting confluence.”

To be responsive to what our patients require from us,” he sums up, “we need to move beyond our four walls and into the community. We’re involved, for instance, in a collaborative pediatric obesity program. Obesity, of course, is a national problem. Our efforts in educating people at an early age is a preventative measure that we feel goes beyond saying we exist only to take care of the sick. Reaching out to the schools and working with them is all part of the positive approach we take to answer the challenges confronting us.”

His earlier assessment of Huntington as a major business prompts me to ask what the best business advice was that anyone ever gave him.

I don’t know that it’s really ‘business’ advice as much as it is ‘life’ advice,” he candidly replies. “I’ve always believed that it’s important to stay optimistic, positive and have that transcend into whatever you’re doing.”

He points to a sign behind me that says “No Whining.” “I really believe in that,” he says. “We can all complain about what we don’t like but unless hospitals and communities - and our society, for that matter - work together to bring about positive changes, what does all that whining get you?”

He also asserts it’s important to maintain a proper balance between work and the rest of your life. “We make a big effort here at Huntington to reinforce that message with our employees. We recognize that many of them work 12-hour shifts but that they also have families and homes that need them as much as we do.”

Last but perhaps most importantly,” he adds, “it’s critical to listen effectively to what our patients are saying, what our employees are saying, what our physicians are saying, what our community is saying. As we take that all in and plan for the future – whether it’s new buildings, workforce issues or changes in how we’re going to treat illnesses – we can go forward with the knowledge that we have a better understanding of expectations and of the job we’ve been entrusted to perform.”

He grins. “At the end of the day, our mission isn’t to balance the books. It’s to take care of the people who need us. If we do that, well, balancing the books will be easier.”