Joel Seligman is plying the hallways of Northern Westchester Hospital with his industrial-looking, oversize rubber-tired “tea cart.”
“Anyone want tea? An apple?”
A few workers shoot him a furtive look. He gets takers at a nurses”™ station up on the fourth floor.
His mission is not to sell the tea, fruit or snacks, but to hand them out and listen to any concerns the employees ”“ which number 1,000 ”“ have with work, the hospital or whatever.
“No one feels appreciated enough in their work. We should have another 200 employees here. When you see how hard our staff works, it”™s insane.”
He”™s not a busybody nor a spy, but rather the president and chief executive officer of the Mount Kisco hospital.
“I can come out and say thanks and ask is there anything I should know that can help you; even if the answer is no, there”™s an appreciation that someone cares enough to ask ”¦ senior people try to make rounds a lot; you collect a lot of good information.”
There aren”™t many high-ranking company executives who push around carts, let alone be seen without a tie.
His stance on the tie is reminiscent of a Jerry Seinfeld routine.
“I”™m not fond of who invented the necktie. And it”™s been medically shown to restrict the flow of blood to the brain. And who needs to encourage that kind of biology?”
When he”™s not gleaning information directly from the hospital employees, he hears from a dozen of his department managers during informal monthly lunches. The most recent one included a cross section from comptroller to a physicist to a charge nurse.
Fashion aside, Seligman has a relaxed style, whether he”™s talking with staff or managers.
“I think it”™s important for me to comfortable and I think it”™s important for other people to be comfortable, so I”™m not a very formal person. First of all, people have to try to have a little fun at work. I don”™t have the greatest sense of humor in the world, but I look to bring that out in people because I think it”™s real important that when they get a chance to stop caring for a sick patient upstairs they actually relax at lunch.”
He”™s working at creating a culture within the hospital that encourages staff to offer criticisms when called for and suggestions for making things better. It”™s part of his quality improvement plan to make workers comfortable saying what they”™re concerned about. “That”™s how you get better.”
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FEEL-GOOD FACTOR
When Seligman joined Northern Westchester in February 2001 after 17 years at Mount Sinai Hospital in New York City, he found a place that held standards and quality high ”“
something he didn”™t want to break.
Morale was high when he arrived and he knew from experience that is a major plus for a hospital or any place of business because it translates to customer satisfaction.
“If the people who work in our cancer center feel real good about working in our cancer center, the patients will feel real good about getting cared for there.”
If one were to graph patient satisfaction day to day, Seligman said, it would exactly mimic employee satisfaction.
“I think if the senior people are very focused on that personal connection with the staff and caring about them as people with complex lives and pressures and stresses they”™re trying to balance,” then it translates to patient satisfaction, he said.
The hospital uses its employee congress to keep everyone informed about issues, planning and decision-making.
“We have big decisions to make about our benefits program next year. What we should do about that benefits program affects them directly. The employee congress has been a very living, dynamic group of employees from all over the hospital and they have committees on internal communications, that”™s the Village Voice Committee, that”™s who sponsor the tea-cart rounds and also our town hall meetings.”
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The meetings are held twice a year over several days and provide employees with information on the pertinent issues. Seligman and other managers can talk to as many as 100 people during the day or as few as two in the middle of the night.
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BACK IN BLACK
At the recent managers luncheon, Comptroller Michael Mascia said the hospital after an off-year last year is on track for a profitable year in spite of the financial strains imbued by HMOs.
Profit and hospital generally aren”™t uttered in the same sentence.
Seligman put it in perspective.
Nationally, hospitals average about 4 percent or 5 percent positive operating margin. “I”™m talking in general about not-for-profit hospitals, because that”™s the vast majority of hospitals in the country and almost all in New York state. So 4 or 5 percent for us would be about a 7-, 8-, 9-million-dollar operating margin. In New York state, the average hospital loses money on operations. Last year, this hospital lost over a million dollars. It was the first year in five that we hadn”™t been in the black.”
For four years in a row, Northern Westchester had been in the black by about 1 percent or 1.5 percent. Last year it was off by about 1 percent.
“This year our goal is to have a $1 million positive margin, which is two-thirds of 1 percent. That”™s our goal; and we”™re on target for that.”
And sometimes a loss is a blessing in disguise. The hospital”™s monetary loss in this case, was a win for children; no major viruses made the rounds.
“Almost every year a rotavirus goes around, knocks all kinds of kids from all over into hospitals. We had the quietest winter in decades in our pediatrics unit. That”™s a wonderful thing ”¦ doctors did something better; medicines were better. It was a million-dollar hit to our budget. It”™s hard to take that as a failure. Some of this is not predictable; sometimes very good things hurt us financially.”
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THE BANE OF HOSPITALS
And sometimes it”™s the system that inflicts the pain.
It”™s not just more nurses that a hospital needs, but more staff in the billing office, Seligman said, and not at the cost of nurses.
When he was at Mount Sinai, full-time nurses were enlisted to fight the HMOs for payments.
“There”™s a nursing shortage. We had eight nurses doing something that added zero value to the care of the patients. It just deprived the institution of resources and deprived the marketplace of nurses. It”™s not in the public interest and people at some point have to call this for what it is.”
Seligman thinks there is an easy fix, but it”™s politically impossible.
“I personally don”™t think the health insurance industry is adding any value to our system in America. It”™s an enormous cost; between what they spend and their profits and most sadly what we have to spend just to get paid we can be addressing all the needs of the uninsured in America. It”™s not adding any value, it”™s just friction.”
As for an answer, he offers: “I know a lot of people in the health insurance industry don”™t like it when I say this, but I personally think Medicare works really well as an administrative organization. That”™s not going to happen.”
“The Legislature just passed legislation that says they (HMOs) have to pay you for something that”™s been pre-approved. You would think that wouldn”™t be necessary. You wouldn”™t think that would be our big achievement for the year, because now there”™s a law that says they have to pay us for stuff they told us to do.”
As far as following a socialized medicine model, Seligman said he doesn”™t know if that would be his choice.
“What I want is a single payer. I don”™t have any problem that private doctors and private hospitals deliver care and aren”™t controlled by the government. I”™m not sure the government can do that better. What I am sure is that the government could figure out a single way to pay, just the money part of it. Maybe there”™s other parts that would make sense.”
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EXPANSION TIME
Northern Westchester has an emergency room busting at the seams, handling a volume two to three times more than for which it was designed. To address the burgeoning numbers, the hospital held a capital campaign that raised a little more than $31 million to build the new David and Mary Boies Emergency Department and the new Cancer Treatment and Wellness Center, among several other projects. The amount was bolstered by a $5 million donation from the Boieses and $1 million from Martha Stewart.
The project is expected to be completed in the fall of 2009.
Having worked in both large and small hospitals, Seligman said small is better.
“Scale works against delivering personal care. Personal care is not just a nice thing, it”™s a safe thing. That”™s why more people are realizing there are real safety advantages being in a small hospital. We”™re not going to have four people with the same name in our hospital today.
“It”™s not a criticism. And those people are phenomenal, but there are advantages to being in smaller hospitals. Especially if you can amass the clinical talent that this hospital has and is located in a place where lots of wonderful doctors live. There are geographic areas where you cannot replicate this hospital. No matter how good are the administrators. We have a lot of things going for us in Mount Kisco that we”™re fortunate.”
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