Monthly Update - January

Happy New Year! I hope you came through the holidays with a spring in your step. This isn’t always an easy task, but here we are – 2012! Now, as usually happens when a year turns over, there is change in the air.

Adventist Health System (AHS) has asked me to move to Florida Hospital Memorial Medical Center in Daytona Beach to take on the role of President/CEO. This is consistent with the national AHS model, in which the regional leader also acts as CEO of the area’s largest facility.

After 5 ½ years at Florida Hospital DeLand, it is no easy thing for me to leave. This hospital is special. The medical staff is committed, the hospital staff is close knit and hard working, and the community is engaged – the spirit of the place is incredible. I’ll miss being here on a day-to-day basis with this talented team. The silver lining for me is that I will continue to be highly engaged with the hospital as I will chair Florida Hospital DeLand Board of Directors in my new role.

I’m also pleased to leave the organization in good hands. Not only will Randy and Pat continue to ably run hospital operations, but Mark LaRose will join the organization as Interim CEO. Mark is a talented and experienced health care leader who has led multiple hospitals around the country of varying size and complexity. During his current tenure at Florida Hospital Memorial Medical Center, Mark led the completion and relocation of the hospital to its current location, as well as positioned the hospital as one of the nation’s top 50 hospitals. His focus on Patient Experience has driven Florida Hospital Memorial Medical Center’s satisfaction scores to the top 10% of hospitals in the country.

Mark will begin his role as Interim CEO so that two things can occur. First, the Board and medical staff leadership at Florida Hospital DeLand will have the opportunity to work with Mark and offer guidance through the transition. Second, Mark will have the opportunity to get to know the Florida Hospital DeLand team as he considers a long-term opportunity at this hospital. This will provide a smooth and organized transition that will lead to stability and continued growth.

The corporate structure change also impacts the Chief Financial Officer role. As the CFO for the Volusia/Flagler Market, Debbie Thomas will transition with me to Florida Hospital Memorial Medical Center and another CFO will be assigned to Florida Hospital DeLand exclusively (rather than shared with the “market”).

Our plan is to transition each of these roles by February 6, allowing for as much continuity of leadership in 2012 as possible. I know this creates uncertainty, and it has its elements of personal difficulty. However, I’m excited about this hospital’s future and I believe the team of Mark, Randy, and Pat will take Florida Hospital DeLand to new heights.As usual, if you have any questions regarding this transition, please feel free to stop by the office, or contact me.

--Daryl

Monthly Update - December

I hope you had an exceptional November and a great Thanksgiving with family and friends. I know we’re all in the midst of one of the busiest times of the year and appreciate you taking a few moments to read through this update. As it’s the last you’ll review within the 2011 calendar year (since you’ll receive the next one in early January), I thought it appropriate to convey our top priorities as a hospital in 2012.

For 2012, the following 10 priorities will be critical. They are listed in no particular order.

1. Improve hospital collaboration in West Volusia: There are two excellent hospitals in West Volusia and we have the good fortune to be sister hospitals. We need to find ways to work even better together to benefit the community.
2. Maintain strong quality improvement: Our last letter talked about the strides we’ve made over the last few years. We need to continue this journey. Particular areas of focus include ensuring that our electronic medical record becomes easier for physicians to use and growing the consistency of our hospitalist program.
3. Provide a top-tier patient experience: Our “Patient Experience Starts With Me” campaign has led to significant improvements in service which we want to build on in 2012.
4. Enhance organizational efficiency: You hear all the time about how much money is wasted in our national health care system. We know it’s true and want to be sure we don’t add to the problem in our community. We want to find ways to improve patient flow, more firmly implement best-practice care, and use proven techniques (like Lean) to help us do this.
5. Focus resources on nursing education and competency: We have exceptional nurses that are core to our quality improvement. We need to invest in their growth and development. We also know that new nursing graduates often need significant additional training before they are ready to independently care for patients. This is something we must do very well.
6. Improve community access and knowledge about Florida Hospital DeLand: Our 50th anniversary is in 2012 and we look forward to using this as an opportunity to involve our community in celebrating our past and building our vision for the future. We also want to be sure our pricing and insurance contracts provide optimal access to community residents.
7. Increase the well-being of our Primary Care Physicians: PCP’s are the foundation of a strong medical community. They also take the brunt of change across health care. National trends from hospitalist medicine to computerized physician order entry have created a difficult environment that we want to help ease as we work together.
8. Plan our continuum of care for the future: We want to continue to develop into an organization that cares for individuals from beginning to end of life, rather than just when illness strikes. We have developed areas of prevention and wellness as well as chronic disease management and want to continue this journey.
9. Energize premium services: Certain services are core to hospital success. These include surgery, cardiology, orthopaedics, and oncology. We have worked hard in 2011 to invest heavily in these areas and will continue to focus on growth in 2012.
10. Enhance the hospital environment through facility improvements: We have developed a master plan that allows for the expansion of space in our emergency room, the addition of private rooms, upgrades to our operating rooms, and growth in our cardiac cath lab. We hope to begin several of these projects in 2012.

Our board and medical staff leaders have put substantial time into assisting us with these priorities. I would welcome your input as well. The hospital is a community asset and I want to hear from you if you think we’re missing the mark in some area.

In the event you’re still awake by this point, I did want to heap a little praise on our Orthopaedic program. On Friday, November 18, the Joint Commission arrived at our request to review our service for specialty certification. The survey went exceptionally well and we have received word that we will receive the accreditation. This will make us only the third hospital in Central Florida to have accomplished this (Tampa General and Florida Hospital Celebration Health being the other two). Something for our community to be proud of!

As has been the practice over the last several months, I’m including information on a special group of physicians working in our hospital. In this case, we feature our Gastroenterologists. We’re fortunate to have an exceptional group which you can see in the attached overview.

I hope you have an excellent December with happy holidays, a Merry Christmas, and bountiful blessings. Thank you for supporting Florida Hospital DeLand. As usual, please feel free to contact me.

--Daryl

Monthly Update - November

As we enter the month of November, I want to spend some time being thankful. It’s easy to whine and complain in the current environment, but the truth is we have so much to be grateful for. There is so much progress being made at the hospital on so many fronts. Consider areas related to quality and service to our patients.

There are several critical measures of quality in a hospital. The first is overall mortality. Our mortality rate at FH DeLand was 1.14 at the end of 2006. It is now .78, a full 32% reduction. We now run 22% below the expected mortality for our mix of patients compared to 14% over the expected mortality rate 5 years ago.

Another set of measures related to the quality of care are our Core Measures as defined by CMS (Medicare). These are measures of the processes of care (we call them pathways) used to treat patients in common categories of illness. They fall into the four areas listed below. I’ve also included our percentage of patients that were treated according to all of the pathway elements five years ago and the percentage of patients treated according to that criteria today.

Core Measure

Pneumonia

2006 92.25%

2011 96.13%

AMI (Heart Attack)

2006 89.85%

2011 98.40%

HF (Congestive Heart Failure)

2006 78.73%

2011 98.92%

SCIP (Surgical Care)

2006 87.65%

2011 97.61%

In the area of service, we send surveys to all of our patients to determine their level of satisfaction with the care here. You may hear us refer to this as HCAHPS as that is the acronym that represents the program all hospitals are required to follow by the Federal Government related to Patient Satisfaction surveying. When we started tracking HCAHPS scores, the percentage of our patients that gave us the very highest scores (9s and 10s on a scale of 1 – 10) was 42%. Now, our performance has increased to the point where 62% of our patients are giving us 9s and 10s for their overall satisfaction with the care here. This represents a dramatic and intentional change in culture and care and is something we’re very proud of.

Truthfully, a letter on this topic could go on for many pages. Florida Hospital DeLand is truly a hospital to be proud of. The results we achieve here must be credited to the focus and effort of hard-working physicians and staff who are committed to the best. The results of this work not only make us a safe community hospital, but make us the best hospital in our area in many categories.

An example of this is our emergency room. Today, the average wait a patient experiences from entering the ER waiting room until seeing a doctor is less than 30 minutes as compared to 84 minutes in 2007. This level of efficiency has driven the percentage of patients who leave the emergency room without being seen (out of frustration or for some other reason – seeking out another care location, for example) from 2.8% in 2007 to 1.8% currently – while seeing an additional 4,000 patients! A national ratings organization recently listed our emergency room as one of the top 5% in the country. Truly something to smile about.

It’s appropriate that we should be talking about our emergency room as we will be celebrating the group of physicians that have been providing emergency care in West Volusia for 35 years during the month of November. The group, led by individuals like Dr. Charles Duva, Dr. Owen Hunt, Dr. Stephen Knight, Dr. Tracy Weiner, and others will be celebrated at our 4th Annual Health Care Recognition “Trailblazers” Dinner on Wednesday, November 16 from 6:00 to 8:30 p.m. at The Club at Victoria Gardens. We would love for you to come join us. If you’re interested, please call (386) 943-4487 for more information.

While we’re on the topic of celebrations, we’ll be having our 8th Annual Celebration of Thanksgiving on Friday, November 18 at 7:00 p.m. at First Assembly DeLand, 551 S. Kepler Road. As usual, this will be a refreshing program of music and ministry that will provide a great way to kick off the Thanksgiving season. For more information on this event, feel free to call (866) 328-6417.

Now, as we close this latest letter, I wanted to make note of the physicians who practice on our staff as Neurologists. Please review the attached document that introduces you to these exceptional physicians.

As usual, if you have any questions or comments please feel free to contact me.

--Daryl

Monthly Update - October

just finished a very busy month at Florida Hospital DeLand. Our Interventional Cardiology program continues to grow with over 42 PCI procedures completed since July 9. This is well ahead of our expectations for less than 3 months into the program! Most of our other services saw increased volumes leading us to believe that perhaps a few snow birds have found their way back to town! So, in this letter we are going to focus on the fun things.

First of all, 2012 will mark the 50^th anniversary for Florida Hospital DeLand. We are in the midst of planning events that will start this month and continue through the end of 2012. These events will focus on honoring our past and describing our vision for the future. They will also be a lot of fun, including a giant “twisting” party in Downtown DeLand next October, hosted by Chubby Checker (the twist having been the #1 song in 1962 when the hospital opened). We’re including a preliminary schedule of activities so you can get them on your calendar early! Also, you may enjoy seeing a promotional video we prepared to kick off our celebration. Just follow this link and brace yourself: Video

Secondly, the Pink Army is mobilizing again. This significant cancer campaign engages our community in activities to help fight the enemy that is Cancer. Join today!

Finally, in our ongoing feature of the physicians that make this hospital work, please find attached an overview of our Orthopaedic physicians. Our Orthopaedic Center of Excellence has been leading the way in quality and service for several years and we’re proud of the physician partners that make this happen.

Please also take a moment to review the Florida Hospital Policy Alert. It is posted on Facebook right now for you to read. Florida Hospital is very concerned about these drug shortages and is actively monitoring the issue.

If you have any additional questions for me, please feel free to contact me.

--Daryl

List of Events:

Physicians:

Monthly Update - September

Considering we just dodged Hurricane Irene, I’m feeling blessed as we close out the month of August. In addition to weather-dodging, August has been a month of planning for the future – a process which also leads to feelings of reasoned optimism. Our executive team has met to discuss a long-term vision for the future, and our Board and Medical Executive Committee have provided clear direction on priorities for 2012. In fact, Florida Hospital Fish Memorial and Florida Hospital DeLand have even met together to discuss the best ways to maximize our presence in all of West Volusia.

Planning for the future always requires a strong foundation of long-term goals. In this letter, I’d like to summarize our draft goals for you. In future letters, I will be able to share our specific priorities for 2012 and you’ll be able to check back to see how those action-items tie back to the longer term goals (since you keep all of your letters, right?) I would also appreciate any feedback you have prior to us finalizing these foundational objectives.

Our 10 Success Drivers: 2012 – 2016

1. Develop opportunities for collaboration and alignment with physicians to drive hospital strategic initiatives and accommodate the needs of our growing community.

2. Optimize hospitalist performance.

3. Enhance the development of knowledgeable, action-oriented leadership.

4. Vertically infuse hospital culture with a passion for outstanding patient experience.

5. Drive the discipline of continuous process improvement across the organization.

6. Collaborate with clinical/medical leadership to improve patient outcomes through the use of results-driven best practice.

7. Focus organizational resources and energy on priority services: Cancer, Cardiology, Surgery and Emergency Services.

8. Establish a full continuum of services from wellcare to sickcare through partnerships, ownership, education, and communication.

9. Manage the cost structure so that expense growth is less than or equal to net revenue growth.

10. Evaluate services to ensure that they have a positive impact on the hospital’s financial stability.

Before I close, I want to thank all of you for attending our Cancer Center open-house on August 21. It was a significant success on a very hot afternoon and I appreciate your support.

I also want to welcome a new physician to our community. Dr. Joanne Sterling has joined Dr. Brent Schlapper as a new primary care physician in his practice directly across Stone Street from the hospital. Dr. Sterling is a delightful physician who will have a positive impact on our already strong primary care network in West Volusia.

Finally, I want to point your attention to five exceptional General Surgeons we have practicing in our community. As with prior letters, we are including information on each surgeon to assist you in finding a quality physician in the event you have a need. Enjoy!

If you have any additional questions or comments, please feel free to contact me.

--Daryl

Monthly Update - August

I’m sitting here writing this a day after the stock market dropped by over 500 points. Europe is in some level of disarray as the sovereign debt crisis broadens and concerns grow about the health of Spain, Italy, Greece, and other Euro countries. In fact, a number of European leaders have been blasted in their press for even taking a summer vacation instead of “fixing” the financial problems being faced. In the US, we have a new debt ceiling after much wrangling, though there’s no evidence that fact brought any calm to the markets or the economy as a whole. Interesting.

Recently, Volusia County held their quarterly economic briefing which provided a look at how we’re progressing closer to home. I won’t bore you with all of the details, but there is some interesting information on unemployment and foreclosures.

In the city of DeLand, unemployment held steady at 10.6% in April and May before jumping to 11.7% in June. There was a similar story in Deltona with unemployment sitting at 11.6% (April), 11.5% (May), and then 11.9% (June). Unfortunately, Deltona and DeLand hold first and second place in unemployment for Volusia County. You can compare our local rates to Port Orange and Ormond Beach, both at 8.5%. Not so pretty.

To add one more element to the picture, Deltona and DeLand saw the first and third highest levels of foreclosure in June with over 160 in Deltona and over 100 in DeLand. Daytona Beach was in second with over 130. Given the relative size of the DeLand population, over 100 foreclosures is nothing to sneeze at.

Now, closing out the trifecta, we have seen the percentage of people covered by commercial health insurance in Volusia County drop from 35% in 2007 to 25% in 2010, and now down to 22%, combined with a state cut to Medicaid reimbursement rates of 12%. Ouch.

In this environment, everyone is suffering and there’s no help in the wringing of hands or excessive whining. However, it is critical that we recognize the economic environment is not turning around on a dime and plan accordingly.

One step we’re taking is to bring a new health insurance product to the market. We are in the final stages of a multi-year effort to bring a product to the market that provides strong coverage, an emphasis on health and wellness, and an affordable price. This will be a product for all of our communities in the Volusia and Flagler County area and is one we feel will meet a significant need. More information on this new coverage alternative will be available in the coming months.

I will now invite you to take a refreshing break from economic news for a few other updates related to the hospital. First of all, we are excited to announce that Rick Robinson will be joining us on September 1 as our new Vice President of Physician Services. In this role, Rick will provide Executive Leadership to both hospital physician groups in West Volusia. He will also coordinate our relationships with our house-based physicians (those doctors that work within the hospital such as Radiology, Hospitalists, ED Physicians, etc.), and engage in our recruiting process. Rick brings extensive experience in these areas and will be a significant help to our teams at Florida Hospital DeLand and Fish Memorial.

By the time you read this, you may have already received an invitation to our Cancer Center celebration. As a reader of these letters, you know that we’ve done significant work to upgrade our Cancer Center and now want to show it off to the community. Please join us on Sunday, August 21 for an Open House from 1 – 3 PM to see what we now have available in DeLand. The center is on Stone Street just across from the hospital in the event you’ve not noticed it before. At the event, we also hope to introduce you to our new Executive Director for Cancer Services in West Volusia.

Last month, I announced the start of our Interventional Cardiology program. It has now been running since July 5 and is a tremendous success. In the first three weeks, 10 patients received life saving cardiac procedures that would have had to be transferred to another facility in the past. I really appreciate the efforts our director, Marlene Thomas, and the team of Cardiologists has put into this program.

Given the start of this new program, I thought it would be helpful if I introduced you to the Cardiologists on staff here at Florida Hospital DeLand. They are a high quality and exceptionally trained group that we are fortunate to have in a community of this size. Additional information on each of them is included with this letter.

Thank you for your continued support of this hospital. Please let me know if you have any questions.

--Daryl

As the year crosses the halfway point, we have an opportunity to assess the health of Florida Hospital DeLand and begin our focused annual planning process. In many ways, this has been an exceptional year for the hospital, and a foundational one for the future. Two cornerstone services bear particular mention.

First, we have completely transformed our cancer center facility and technology. The move to latest generation image guided radiation therapy and in-place Pet/CT (a unit so advanced it is only the second of its kind in Florida) has established us as a top-tier radiation therapy program. In addition, a care navigator is now available to assist patients through the complexities of cancer treatment, all in a cancer facility that is warm and comfortable. You can probably tell I’m proud of this improvement.

The second cornerstone is our cardiac program. By the time you read this letter, our new Interventional Cardiology program (called PCI) will have started. We have been granted a state license with a formal start date of July 5. Our community needs the strongest of cancer and cardiac services and we’re excited to be redefining both programs in the same year.

I’ve mentioned in a number of ways throughout the history of these letters how important a strong medical staff is to a hospital. Due to that fact, I wanted to close each of the next several letters with a profile of different specialties that practice within the hospital. The truth is, we have an impressive group of physicians practicing in our community.

Since most care starts with the Primary Care Physician (PCP), this seems an appropriate place to begin. Primary Care, of course, is made up of Family Practice, Internal Medicine, and Pediatric physicians who care for patients in a comprehensive way and refer them for additional specialty consults or services as needed. It is easy to argue that the relationship Primary Care Physicians have with patients is the deepest and longest-lasting of any in medicine. Therefore, choosing a PCP is one of the most important decisions a patient will make.

The training of our community Primary Care Physicians is exceptional, with graduates from Duke, Vanderbilt, University of Miami, Temple University, Loyola University, University of South Florida, University of Wisconsin, and many other exceptional programs widely represented.

In addition to high-end training, our PCP physicians have impressive experience. In fact, the average time our Primary Care Physicians have been practicing here in DeLand is nearly 16 years. In fact, five of our 25 PCP’s have been practicing in DeLand for over 25 years!

In the event you haven’t had an opportunity to engage with one of our local Primary Care Physicians for your personal needs, I’m including a complete listing of each of these physicians as well as contact information that can assist you in making a selection.

Thank you, as always, for your continuing support of our community hospital. If you have any questions or comments on the content of this letter, please feel free to let me know.

--Daryl