Resurrection head explains system's financial, cultural turnaround

July 1, 2011

By LILAH LOHR

ATLANTA — Resurrection Health Care in Chicago was facing a $100 million operating loss, a growing Medicaid population and a declining market share in late 2008 when Sandra Bruce started her new job as president and chief executive. Then the system's credit rating went negative and the American economy took a nosedive.

Resurrection's board and sponsors were "somewhat forthcoming when they interviewed me," Bruce recalled wryly during a presentation at the Catholic Health Assembly here.

Bruce; Sr. Clara Frances Kusek, CR, executive vice president for mission; and Terry G. Williams, executive vice president for organizational transformation, took a team approach to describing the 18-month turnaround that brought Resurrection to its current status of contemplating a merger with Provena Health, based in Mokena, Ill.

The largest Catholic health system in the Chicago metropolitan area and one of the largest in the state, Resurrection has 11,579 employees including its employed physician network. Its six hospitals, assortment of senior health care and acute care facilities, retirement communities, employed physicians and other components generated $1.33 billion in net revenues for the most recent fiscal year. The system incorporated in 1981 and is sponsored by the Sisters of the Holy Family of Nazareth and the Sisters of the Resurrection. More than 60 percent of patients are insured by Medicare or Medicaid, and the ethnic demographics cover a broad range of languages and cultures. The system's patient base includes undocumented immigrants.

When Bruce arrived, she found a loose confederation of entities, a number of which had been acquired recently without a clear plan for integration into the system and most operating in their own way. "They were working in silos," she said. "We were not organized in a fashion that would allow us to operate as a system."

She also found the system "accustomed to living off of interest and investment income. It created a very false sense of security." She set goals of shaping a culture of accountability, collaboration and transparency and hired Galloway Consulting of Atlanta to help.

The first step in transforming an organization is to get employees at all levels to confront reality. For Resurrection, "this was a shock to many people who thought the system was doing great," said Williams, who eventually left Galloway to join the health system.

Creating a means of measuring accountability and collaboration and instilling them into everyday operations took some doing, Williams said, but these steps were critical to turning the system around and pouring a foundation for the future, which now involves meeting the requirements of health reform. Doctors and staff from all over the system were brought together, for example, to set a standard protocol for sepsis, a collaboration that helped set the tone for Resurrection's culture change.

Resurrection's 18-month journey also involved reevaluating the system's makeup, which led to some employee layoffs and the sale of two underperforming hospitals to help close the system's financial gap. Sr. Kusek brought the sponsors' perspective to the assembly session, and she described the discernment processes during such difficult decisions. "The dilemma," she said, "was to determine how we could sustain our ministry and continue (our mission of) Catholic health care (in Chicago) without eliminating hospital services" in the communities Resurrection serves, a geography that includes groups Bruce describes as "the poorest of the poor."

Bruce said the work she and her staff have done brought Resurrection back to the financial break-even point and resulted in a stunning improvement in patient satisfaction rates. The system is better integrated, physicians are in leadership positions in governance and management, quality of care has improved and the system's operational and cultural foundation are stronger, leaving it better prepared for health reform, she said.

Transformation is never-ending and not for the faint of heart, Bruce said, but a health care system's mission can be strengthened through a transformation process. "The status quo is just not an option," she added.

 

Copyright © 2011 by the Catholic Health Association of the United States
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