Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, June 4, 1995 TAG: 9506020067
SECTION: BUSINESS PAGE: F1 EDITION: METRO
SOURCE: SANDRA BROWN KELLY
DATELINE: LENGTH: Medium
Ask Carilion Health System and the city of Roanoke and Alleghany Health Districts about that change.
As diverse as these organizations are, they're having similar experiences and coming to remarkably similar conclusions as they change the way they do business.
Carilion is a not-for-profit Roanoke company that operates 13 hospitals and other facilities from Farmville to Big Stone Gap and employs more than 7,000 people. Its operating budget is $430 million. By contrast, the health districts, which serve a largely low-income clientele in an area from Roanoke to Clifton Forge, operate on about $8.5 million a year.
Both, however, must become more cost-efficient to continue doing what they do. The hospital system needs to get its costs down to match those of for-profit competitors. The health districts have to change because Gov. George Allen ordered government to get smaller, and to speed it up, offered workers a job buyout plan. A whopping 20 percent of the health departments' staff - 35 people - took the buyout.
On the theory that most of those jobs are gone forever, the health departments are faced with evaluating services to see which to keep and retraining staff to replace the skills of those leaving.
Like Carilion, it has had to change fast.
Carilion held a rare news media briefing two weeks ago to explain to the community - and reinforce for its employees - that it has finished the first phase of a journey that will convert it from a company that depends upon people who are hospitalized to one that tries to find ways to keep people healthy and out of the hospital. And still make money.
Even though new business opportunities can offset some of the losses from the shorter hospital stays of patients, they "won't balance the decline," said Carilion CEO and President Thomas Robertson.
"We have no major layoffs planned, yet we know that our organization will have to be smaller and more efficient in the future," he said.
Robertson also stressed that the company can't keep asking people to do more work. Its only out is to change the way it works.
Carilion first will redesign its management structure to relate the positions to services rather than specific facilities. It also intends rapidly to put in place a retraining program that should help employees' transition into new jobs as they are developed. For example, nurses used to working in a hospital might find happiness as health educators.
Changes will be initiated by employee teams, which are being named this month. That's also how the health departments are doing it.
Initially, Dr. Molly Rutledge, director of the health departments, asked work teams in six service areas to come up with an ideal world, the worst situation and the most workable scenarios for survival.
The teams had to assume that they wouldn't get any more staff and that they still had to provide those services that are mandated by the state; some, like home health care for instance, aren't.
Some of the questions the teams grappled with included: Which child services would be kept? Could the Health Department continue its pharmacy where a package of birth control pills sells for $1? Would it provide dental care as always? How about primary care for adults?
Like Carilion, the health departments don't have a final plan, but they're close; and last week Rutledge previewed it for several Roanoke social services leaders. She will do the same in all of the counties served by her departments.
Also like Carilion, the health departments have thought globally. If a Roanoke city inspector is needed in the county, he'll go, and vice versa. And if Carilion clinics can handle primary care for adults now seen at the Health Department, the health departments might be able to provide low-cost drugs for indigent patients now seen by the hospital clinics.
And like Carilion, Rutledge has kept an eye on the bottom line. The departments' home health program in Roanoke and Roanoke County pays its own way, and it can continue to operate and even expand as long as it continues to be self-supporting, the health director said.
However, nowhere in her proposals, or in any thus far revealed by the hospital system, have there been indications that service to a patient is being blocked by dollar signs. In fact, Carilion; its main competitor, Lewis-Gale Hospital in Salem; and Rutledge have sat down together to talk about how to assure that health care is available to all income groups.
It's too soon to tell, but change just might really be for the better in this case.
Sandra Brown Kelly covers health and medicine and consumer issues for the Roanoke Times & World-News.
by CNB