Q&A: SylviaYoung:

In Business Las Vegas, August 31st, 2007

What do people say is working well?

I think right now people would say it's how we work together as a market. There are four hospitals here with Sunrise Hospital and the Children's Hospital, then MountainView and Southern Hills. We've really worked hard to leverage best practices across the institutions.

One of the best attributes we have across the system is our technology platform. For example, if you had a parent who had heart surgery at Sunrise but they lived in the southwest part of town and had chest pain and went to Southern Hills, the emergency room doctor could pull up their laboratory results, their blood results and their X-ray results in real time and understand what happened to the care of the patient when they were at Sunrise.

What are the things that people want to improve upon in the next few years?

I would say greater leadership visibility.

Does that mean you're going to walk around all the hospitals?

It does, and I like that!

They want greater leadership visibility both inside the hospital and externally, a lot of energy around telling our story more in terms of getting the good word out about what the Sunrise Health System does.

You mean marketing?

Marketing, public relations, doing this kind of thing. People don't want us to be the best-kept secret. There's a lot of pride around all of the organizations.

We've got very engaged physicians. I've not seen that in other markets. The doctors here want to be in leadership positions, and they work very closely with senior management.

What are some of the projects you've set up for yourself?

One of the goals that we have is to take the Nevada Neurosciences Institute and really take it to the next level to get both regional and national recognition. What we have is a collection of highly trained subspecialty neurologists who take care of patients in the inpatient setting and very highly trained neurosurgeons and spine surgeons.

We are opening a Spine Institute Center of Excellence at MountainView. We are looking at opening that same service in 2008 at Southern Hills.

We want to partner with the Nevada Neurosciences Institute Research Foundation to bring more research dollars into Nevada and more academic physicians who want to practice, research and really improve the care of the neuroscience patient in the community.

How are you going to work with some of the other medical research institutes here such as the Nevada Cancer Institute and the Lou Ruvo Brain Institute?

We are very open to partnering with any of those physician groups or with the Ruvo Institute. I know we have had people visit that organization. We don't have any clear-cut, defined partnership at the time, but we're certainly open to what the opportunities might be.

Talk to me about expansion plans, about the new hospital, for instance.

The medical office building is not completed yet. Nevada Orthopedics is the owner of the building. We are in negotiations with them to have a significant presence there.

They don't own the land, right?

Sunrise owns the land, and we have a relationship with the physicians in terms of a ground lease. They have the medical office building. What we're looking at is additional outpatient services that are very convenient and accessible for people in that community.

We are not planning to break ground on a hospital at this point in time. This is Phase 1 of Sunrise's Health's entree into that community.

You asked me earlier about some of the programs I wanted to see take off at the organization. One of the goals is to have all of our patients basically be raving fans when they leave our organization. We are implementing across our three hospitals a concierge service. When you figure we are in Las Vegas with world-class hotels, great amenities, great hospitality and great services, it seems intuitive you would pick a concierge service that's a natural at the Four Seasons and bring it into the hospital setting.

We're working with a national company called Best Upon Request. The services we're providing are designed specifically toward patients and their families. We have a huge amount of patients from Northern Arizona who come here for neurosurgery, for example. A lot of times when people are transferring in by helicopter or ground transport, they didn't expect to be here. They may have a pet at home or a child at a day care center. We had a situation when they wanted to get a cat shipped home and, honestly, it was affecting the healing process.

The concierge service will help patients and families with those kinds of detail arrangements so they can focus on healing and getting better.

Other things they're doing is finding hotels at discount rates. Any kind of service we can provide to make this patient- and family-friendly.

Here's an example I'll give you. When I was making rounds a couple of weeks ago, we had a mom and daughter out here for her bridal shower before she got married, and they thought Mom had a stroke. They were here for five days, and the daughter said: "If I just had access to a computer to look at different flights going back ..."

Now we have concierge service to provide a laptop or whatever she needs to get home.

We had a patient from Alabama who fell down an elevator, and he literally had the clothes on his back. Now the concierge service has a stash of clothing so if they need some, we can provide that for them.

We get a lot of patients off the Strip who are here visiting, tourists, in addition to those from Northern Arizona . It makes us a different hospital in terms of what their unique needs are rather than somebody who came in from the street to have a routine operation.

Has that been used at other HCA properties?

It's been used as an employee service. We used it where I came from in Denver for things like dry cleaning, UPS mailing, go to get stamps, or somebody said: "I left my iron on at home." I call it having a wife: Everybody needs a wife at home.

We have such a unique setting here in Las Vegas with so many people unfamiliar with the environment and coming from out of town. The early launch has been successful.

It seems like your target audience for the concierge service did not plan to be at the hospital, though.

It'll also be for those coming in for a birth, and if your child care fell through and your family hasn't gotten in town yet. They have lots of vendor-management relationships in town. It could be for anything like that.

I was also going to ask about the competitiveness with the Valley Health System. You are both right up there as the biggest local hospital chains. How much does that factor into your decisions — putting yourself above your competitor?

I look at competition like I look at my golf game. I'm always looking to improve against my own benchmarks. You're not trying to beat the other player in the golf cart as much as you're trying to improve against yourself.

We have, in our system, awesome physician satisfaction. At MountainView 100 percent of physicians said it was a hospital they'd recommend for family and friends.

At Southern Hills we had the best inpatient satisfaction we've ever had last quarter.

They're so bullish about their ER at Southern Hills, they have a poster that says "Short ER Waits."

What we do is focus on what our internal benchmarks are. How do they compare against the national Gallup polls for patient satisfaction and patient safety goals. We really try to set our benchmark to improve against ourselves. We've already set a pretty high standard. We can just try to get better at patient satisfaction, physician satisfaction and clinical outcomes.

I've written about the Magnet Recognition for nursing excellence. I thought it was interesting that all of the Sunrise hospitals are working together on their applications.

What we are doing is having our three chief nursing officers evaluate what the (goals) are and work together. They are things like evidence-based medicine and research in your clinical practice. Every town hall meeting I've had, one of the nurses has said, "Can we get to magnet status?"

We're at the foundational portion, looking at what kind of plan do we need.

In my previous hospital we were about a year into the journey, and it really is as much about the journey as reaching the destination.

One of the things I've loved about being in this market is the sharing of best practices. I'll give you an example. If Southern Hills has really great inpatient satisfaction and they did something new, we've got a ready forum every Friday where the chief nursing officers are together.

What I heard people say is that Magnet hospitals will really have an edge when it comes to recruiting nurses. Do you really think that's going to happen based on what you've seen?

What's really going to give you an edge is a couple of things. You want to have doctors feel so good that your environment is so safe they'd have their mother here.

One of the things we're proud of is our patient-safety initiatives. You know how you go to the grocery store and the food is barcoded? In the HCA system, every medication is barcoded.

We paid to have a robot sit in the pharmacy because the pharmaceutical industry hasn't caught up yet. The robot puts the barcode on the medication package. The medication gets to the nursing unit, and the nurse uses a scanner to scan the patient's identifier, scan the medication and look at the computer. We want to make sure it's the right medication for the right patient at the right time. You'd think it would be a simple process but people get busy.

This is EMAR — we call it Electronic Medication Administration Record. The barcoding of medication has made huge strides in patient safety. Yet when you look across the country less than 8 percent of hospitals have this patient safety initiative.

I think when you look at differentiators in health care, patient safety is huge. I don't know if you know of our MRSA campaign — basically it's prevention of staph infection in hospitals. There's a huge amount of research about staph infection and how hospital-acquired infections occur. Throughout this organization we have bottles of hand sanitizers everywhere.

It seems like HCA is trying to position itself nationally as far as being known for patient safety.

There was an article about Dr. Jon Perlin (HCA's chief medical officer) in the Wall Street Journal. One of his first launches was this MRSA initiative. Literally when we do patient rounds we're walking around asking employees: "Are you washing hands?" It's been known to reduce the spread of infection.

The industry is having what we call "never events" — like operating on the wrong limb or having a hospital-acquired infection come from not washing hands properly. In that article, he was talking about this whole MRSA initiative. There are dollars tied to it in terms of reduced patient length of stay, reduced hospitalization and patient satisfaction. They don't want prolonged length of stay in the hospital.

I've seen the government and private companies rank the hospitals nationally, so you've got this number attached to you. I guess this is a good way to get the numbers up.

What I compare it to is I wouldn't buy a car without going to Consumer Reports and looking at safety evaluations.

I think there are going to be ratings, and the interesting part about the ratings is that some of them are based on processes and whether or not you document in hospitals. Others are truly based on meaningful clinical outcomes. I think the public is going to be confused for a while because there is so much data coming at them they're not going to know how to interpret it. We are really going to have to work with the community.

Let's talk about the Las Vegas market. How are you going to plan and tackle both the doctor and nurse shortages?

Let's talk about physician shortages for a minute. I believe we are 47th in the nation for physician shortages in key specialty areas. What attracts world-class physicians, I believe, are three things:

First and foremost, a safe patient environment (is important), like the computer access we have to lab reports or the bar-scanning technology.

Secondly, I think they're looking for technology and innovation in health care. At Sunrise we have the only gamma knife, which is part of the Nevada Neurosciences Institute. We have two robot surgical machines, and we're the only ones in the valley that have that. We have the largest gynecological program for the robot this side of the Mississippi .

Finally, they want competent professionals taking care of their patients. We just got the annual physician satisfaction surveys for all of the hospitals in the market.

Is that something you conduct yourself?

No, we use something called DRM, Data Management Research. They compare you against your prior years' scores, then they compare you against hospitals of like size. In every category, they ask: How would you rate overall nursing scale? That has the highest correlation to physician satisfaction with hospitals.

Our hospitals in the Las Vegas market were higher than hospitals of same size across the company and improved over prior year, and that's very, very telling. I think all of those really package to bring doctors into the community.

In our Children's Hospital, we're finishing a $75 million renovation and expansion project, and in October we'll finish the final touches on our women's and labor and delivery unit.

We have, I think it's one of the best-kept secrets in Las Vegas , one of the largest pediatric heart programs in the country here. It's a group of top cardiologists and heart surgeons who provide care for all of our patients in the Nevada area. It's just a spectacular facility. I think all of those things lead to physicians coming into the community.

One of the questions you asked me was what are some of the challenges with recruiting physicians. One is that you cannot employ physicians in this state. If you have top-notch faculty or salary docs who maybe have come in from an academic setting, a lot of them are risk averse, particularly if you are used to having a salary come in.

The fact that we can't employ doctors here makes it difficult, and we have to get creative. If we can't employ them we have to make what I call the mousetrap very attractive in terms of facilities, clinical care and the nursing staff.

Does the hospital group go out to recruit?

Yes, we do. We do Web sites, we go to national conventions. All of the different doctors have annual meetings they go to. We do news articles. We have a lot of e-mail interaction. Most doctors now will go on a Web site. We have a full-time physician recruiter who recruits for all of our hospitals here, and we have a national recruiting arm out of HCA.

If we've got a physician who is coming out of UCLA and wants to look at Austin , Denver and Vegas , we've got a national system that can deploy those recruiters.

Talk about nurses now.

We have a couple of different ways we attract nurses. One is a Nurse Apprentice Program. The shortage is not because people don't want to go to nursing school — the shortage is that we don't have enough faculty across the nation to teach nurses and get preceptorships in the hospital.

With NAP, we marry the didactic part of their clinical training with hands-on practice. That has been very well-received by the nursing schools.

You do that for the schools?

Yes. Two years ago, one of our CEO's daughters died an untimely death of leukemia. HCA donated Nevada State College, which I think was still in a startup mode, for nursing scholarships.$450,000 to

For us, clearly you've got to support the profession. That means providing scholarships, providing preceptorships in the hospital and hiring new grads. If new grads can't get jobs, who's going to go into nursing shcool?

That's not a problem in this market, right?

Not here, but it has been in others. Some hospitals in certain fields only want to hire experienced nurses.

I think the other thing is the image of nursing has changed. It's no longer passing a pill and giving a patient a shot and cleaning a bed pan. It's a high-tech, science- and evidence-based practice field now. When nurses come in and you show them we have these new Giraffe Beds in the NICU or what we have in radiology, or when they get to work on robotic technology, that attracts nurses into the industry.

I think the most important thing is providing what we call a healthy work environment. Nurses want a voice in the environment. If they don't think they're going to be heard, they're not going to stay in your hospital for very long.

One of the things I started when I got here was a CEO Town Hall meeting. Every other month I invite employees to come into the auditorium and I'll usually do a 15-minute presentation.

Then I give them index cards in case they're shy. They can write any question they want. We do a Q&A session just like a politician would do a press briefing, though I don't want to be compared to one. But it's a real open dialogue.

We print the questions and answers on an e-mail. The employees have responded very positively to this. Every Friday I have a "Friday message from the CEO." It goes on electronic mail, and a lot of times it has excerpts from patient letters highlighting employees.

That way people see their names there ...

They love it. We just had a physician whose father died here and he wrote the most poignant letter naming staff and those who attended to him. They love seeing that. I have employees who like to start their weekend with a Friday e-mail.

The other thing I've started, monthly, is I do a birthday lunch. I do it every month. They get an invitation to come to lunch. It's not just to meet me. We have cake and we have lunch. A lot of times I ask them what's the rumor, what do they like about their work environment, what can we do to make things better?

Are those all things you did in Denver ?

Two of them I did. I did not do a Friday e-mail before. I got that from a national meeting at HCA where they were sharing best practices.

Have you met with the nurses union? Have they been involved with you since you've been here?

My extent of interaction with the union has been a couple of nurses coming to my town hall forum and introducing themselves. They've been very warm and engaging. Fortunately, my predecessor negotiated a long-term agreement with the nurses union. I'm here at a good time.

Really, their goals are the same as our goals, which is to provide superior patient experiences and have evidence-based medicine. The nurses I've met are very engaged and supportive and, frankly, very proud to work here. I haven't noticed a difference whether they've been union or non-union nurses. They've all been great to work with.

MountainView is the only HCA hospital to not be unionized. Do you have any indication that they are going to try to organize MountainView?

We have not been given any indication they are going to try to organize MountainView. I can tell you, MountainView recently had one of the highest employee satisfaction surveys in the division. Generally I think if employees feel like their voice is heard and they have high satisfaction they won't go to a third party. I don't have any intel that would make me think there's union activity happening there.

Another contract issue is the Sierra Health Services insurance contract. Do you foresee renegotiating that contract?

Right now it's a clean sheet of paper. I was not involved in any of the previous issues or acrimony. I think we are open to the possibilities. Right now I think they're pretty busy in terms of working on their contemplated merger with UnitedHealth Care.

There's nothing in the short term, but I'm open to possibilities.

And HCA has a relationship with UnitedHealth.

Yes, across the country. And we do have a relationship with Sierra with the pediatric heart care that we provide here. I talked earlier about Children's Heart Center. They felt it was very important, as did Sunrise, that children in Nevada receive health care at the only children's heart hospital in the state. We do have a carve-out agreement with them.

It was UnitedHealth Group that had the similar contract dispute with HCA in Denver . How long was that contract for?

The dispute was for 90 days. We have a contract, but the specifics of the contract are still being negotiated.

Do you want to add anything else?

We are a tremendous community asset. When the Nevada Development Authority and the Chamber of Commerce go out to recruit corporations to relocate to Las Vegas , I would like to think that the Sunrise Health System would be perceived as an innovator and a leader in the provision of medical care. When Somer (Hollingsworth, president and CEO of the Nevada Development Authority) is going out to companies with the top 10 reasons why you should bring your company to Las Vegas , I want the Sunrise Health System to be on that list.

Do you know if that is something that companies ask for?

Absolutely, particularly if they are relocating people who have chronic conditions. Or if they want to know if they are there enough OBGYNs in the community if they have a young, child-bearing population.

I'd like to see that become a talking point in the business community. It's not just (attractive to have) the great lifestyle, gaming, convention centers and the growth — it's also the health care community.

"I think the most important thing is providing what we call a healthy work environment. Nurses want a voice in the environment. If they don't think they're going to be heard, they're not going to stay in your hospital for very long."

SYLVIA YOUNG , Sunrise Health System