After almost two years leading the Regional Medical Center, President and CEO Charles Williams says, “We have come a long way.”
"As we looked at this last year, we are actually very happy at where we are because as we looked at this last year, we were able to quickly see, ‘Wow, we have come a long way,’" Williams said.
Williams noted when he arrived at the hospital, he made it clear change would not be quick or overnight.
"We are probably looking at a two, three to four to five-year turnaround based on the history,” he said.
Williams was named the Regional Medical Center’s president and chief executive officer in November 2017. He arrived at the hospital amid board concerns about the leadership of the institution, which was previously managed by a Tennessee-based company even though it is owned by Orangeburg and Calhoun counties.
Williams, Vice President of Strategy and Marketing Carol Koenecke-Grant and Chief of Finance Liza Porterfield sat down for an interview with The T&D to highlight some of the changes this past year.
While the RMC and its seven primary care practices did see a $1.6 million loss for 2018-2019 -- about $500,000 more than last year -- the three provided a list of goals and accomplishments seen as helping the hospital move forward into the future.
The goals were set by the hospital's board of trustees in May with the understanding that Williams will receive a bonus according to how successfully he meets the benchmarks by the end of the fiscal year. It was unknown by press time how many of the goals were met to the board's satisfaction and whether any bonus has been given.
The hospital officials reported:
• RMC entered into a lab partnership earlier this year with New Jersey-based Quest Diagnostics resulting in improved quality and patient satisfaction through better turnaround times in the emergency department.
The hospital saw about 98 percent of emergency department lab order results come back to the patient in under 30 minutes in August 2019. The hospital’s goal was 90 percent.
Williams said the hospital realized there was a bottleneck in its laboratory department which slowed down emergency visits. He said the hospital has also taken steps to reduce the time patients have to wait in the emergency room to see a nurse or doctor.
"One of the issues we were having is we were not hitting those turnaround times to give doctors and nurses those results to make decisions which would improve peoples' experience at RMC," Williams said. "We are now turning around times faster and the results are in the pudding. We can quantify our number one issue."
"We are trying to chip away at all those areas where they (patients) think there might be a delay," Koenecke-Grant said. "If we shorten up all these critical elements, your ED wait time will be less."
Williams said Quest Diagnostics -- which is the largest clinical laboratory in the nation -- also helps the hospital with recruiting lab technicians.
• RMC opened a minor care area in the emergency department to improve patient wait time. Hospital officials say the initiative has resulted in a 33 percent improvement.
The minor care area aims to place those with urgent care needs on a fast track in an effort to better alleviate emergency care volumes.
• The hospital entered into a partnership with Anesthesia Management Services to reduce delays in surgery start times by 13 percent from March 2019 through September 2019.
"This is a big deal," Williams said. "We are getting them (patient surgeries) started and done so they can get on with their day."
The hospital entered into a three-year contract with Florida-based AMS earlier this year.
• The hospital has focused more on quality and its impact on patient care after the organization receiving a failing grade from The Leapfrog Group in a fall 2018 survey of hospital safety across nation.
The hospital’s grade did improve to a D for the spring of 2019. The next score is expected to be released by year's end.
As part of its improvement goals, the RMC saw its central line-associated blood stream infections (or high-risk infections) for the last two quarters of the year decrease by 50 percent, Koenecke-Grant said.
• RMC celebrated the grand opening of its Women's Health Center on Pelham Court in the middle of August. The center will enable the hospital to see and treat more patients. The center has grown from six exam rooms and one procedure room to 12 exam rooms, one ultrasound room and one procedure room.
"We are receiving great reviews from the patients," Koenecke-Grant said.
The RMC has also recruited two new OB/GYNs for the center.
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• The hospital launched its first-ever intensivist program in August. The program offers critical care patients a doctor specially trained in critical care.
"Many hospitals don't have an intensivist because there are not a lot of them out there," Williams said. "We have a person on site and we also have telemedicine. That is a benefit you rarely see in a rural setting."
• RMC opened the Bamberg Barnwell Emergency Medical Center in April, returning emergency health care to a region that had lost its hospitals in 2012 and 2016.
The BBEMC has seen volumes in its first six months double what was budgeted, with about 7,700 patients being treated since April.
Staffing for the center was outsourced as well, helping to save the hospital about $4.2 million by not having to pay for costly contract staff. The outsource company, Sound Physicians Group, also provides the hospital with a resource for best medicine practices.
• RMC increased security at both the Orangeburg hospital and the BBEMC following a shooting in April. Now the hospital has round-the-clock security with both armed and unarmed guards, as well as bullet-proof glass in the reception area of the emergency department.
A security process has been implemented for all visitors checking into the hospital, a wand security screening has been implemented in the emergency department and exterior access points have been locked off, creating for a safer environment, Koenecke-Grant said.
"The staff is very thankful," Williams said. "They feel safer."
• The hospital has assessed its infrastructure needs on the main campus, with a number of modernization needs identified to enhance patient care and safety.
"We can use new diagnostic equipment and operating equipment in here and do it in a way that is less expensive today and to get the benefit of the equipment today," Williams said.
For example, Williams says the hospital will purchase a new MRI that is larger and more modern with a more spacious imaging tunnel.
"We want to bring equipment that is the latest and greatest," Williams said. RMC plans to spend between $14 million and $15 million on upgrades to the hospital's equipment.
In addition to the MRI, the RMC plans to purchase new X-ray, lab and ultrasound equipment as well as robotics in its orthopedic and urology departments.
• Case management services have been expanded. That has reduced patient length of stay from 5.6 days in the first quarter of 2019 to 4.8 days for the fourth quarter of 2019.
Case management provides a patient the care they need from the time they are admitted to the hospital through their discharge and time at home.
"The process was not being managed well," Williams said. "We are going to make sure you are here a certain amount of time so when you go home, you have the resources you need."
For example, Williams said it benefits the hospital's bottom line to reduce patient hospital stays and to keep down costs which otherwise could be invested in infrastructure and employees.
• RMC has overhauled its home health program, which provides care to homebound individuals. The change in the program has seen the program's census grow from 63 patients in October 2018 to 105 at the end of September.
"This was a program that was struggling," Williams said. "We were not always getting the patient in time, we were having some staffing opportunities and our census was dropping. We believe people in the community had lost confidence in the care we were doing."
Williams said the hospital has completely overhauled the program's management staff.
"We were not doing it in an organized fashion," Williams said. For instance, providers’ appointments would be scheduled from one end of the county to another, rather than being consolidated in the same region.
"The physicians and providers have to trust that the program is good," Koenecke-Grant said. "Now they are willing to refer to their patients. Previously they referred them to someplace else.”
• A strategic plan has been developed for the 2019-2020 fiscal year. The plan examines what hospital programs have been beneficial and adequately served the community's needs, what programs could be added and what could be eliminated.
• A collaborative community health needs assessment and community health improvement plan have been developed that look at what the community says it needs in health care services. The health needs assessment and plan looked beyond health indicators and also touched on such needs as affordable housing and substance abuse programs.
"By partnering with other people, we think we got a clear idea of what exactly is needed," Koenecke-Grant said.
A community health needs assessment is required every three years.
• A nurse practitioner has been added to the Holly Hill Primary Care Clinic. There was no pediatric specialist in Holly Hill prior to her arrival.
Williams said the benefit was seen recently when Holly Hill Academy was conducting physicals for its football players. The presence of the nurse practitioner provided accessible care.