This year Massachusetts General Hospital in Boston celebrated its 200th anniversary. At the same time, the organization is working to cut costs, improve quality and meet various requirements of the healthcare reform law. Peter L. Slavin, MD, president of Mass General, reflects on the hospital's successes in the past year, the challenges ahead and how he hopes to build on a history of delivering quality care to continue exceeding patients' expectations in the new year.
Q: What are the biggest challenges in the past year you have had to face as president?
Dr. Slavin: One is specific to Mass General Hospital: We've been pretty capacity-constrained with limited inpatient beds, operating rooms and the emergency department. Managing the hospital at a time with a very high occupancy and congestion that is frustrating to a lot of people minimizes the opportunity to grow. Fortunately, a few months ago we began opening up a new clinical building that addresses a number of those capacity constraints, so that is making some progress towards addressing those challenges.
The other more broad [challenge] is that clearly as result of the economy and federal budget deficit and state budget deficit challenges, we as an organization need to make a transition from a fee-for-service environment to a more global payment environment and also an environment where rate increases are much more modest than what we've received in the past. How you turn this aircraft carrier around in a way that it can thrive and continue to [achieve] its mission in a new reimbursement environment has been a challenge, and it will be a challenge for many more years to come. On top of that, a significant portion of [our research budget] comes from the National Institutes of Health, and the budget for that federal agency is also quite challenged by the federal budget deficit.
Q: How did you overcome these challenges?
PS: In terms of financial challenges, we're doing reasonably well, but we decided this year to go through a budget review process to prepare for the future environment we're going to be living in in an effort to figure out how we can be more efficient and more affordable going forward. [This is] despite the fact that we are doing better than budget through most of the year — we trimmed expenses by about $40 million dollars a year in an effort to try to better position this organization for a much leaner reimbursement environment. Those efforts will continue this year and for the foreseeable future.
[In our] zero-based budgeting process, we asked all department heads to look at everything they're doing and identify things they could stop doing or things they could do more efficiently. Senior management and I met with department heads to go over their ideas, organizational charts and mission, and made some decisions about things we thought we could implement immediately. We also have a significantly larger pool of ideas that we're going to need some more work on to turn into reality.
The clinical building, which is called the Lunder Building, was designed a few years ago to address the capacity issues of not enough inpatient beds or operating rooms or a large enough emergency department. So, those three things make up most of the space in the new building. That building just opened a few months ago, and it is the largest and arguably nicest building we've ever constructed. And the staff that is now in there love being there and more importantly patients receiving care there are thrilled with the patient-centered aspects of the building. One of our doctors expressed concern that we might see the length of stay go up not because of any operational problems but because the patients might not want to leave.
Q: What were your greatest successes this past year?
PS: The new building would be one. [Also,] this is our bicentennial year — our 200th birthday since being established by the state of Massachusetts — and we had a number of activities going on throughout the year that celebrated that bicentennial. We focused not on celebrating the past, but looking forward on having a bigger impact in the next years than in the past 200. For example, we reenacted the signing of the charter on Beacon Hill. A couple years ago we commissioned a book on the history of the hospital that is now out and called Something in the Ether. And we've also this year given a significant gift to the community for the privilege of operating here in Boston in Massachusetts. We called it the Bicentennial Scholars program, and it's aimed at getting 26 high school students into college and through college in the next six years.
[A success] I would also point to this year is that we [were] awarded by the Association of American Medical Colleges the Spencer Foreman Award [for Outstanding Community Service], which is given to the hospital they think has the best community health program in the country. Mass General is renowned for clinical care, research and educational activities. It's nice to see those things recognized by an organization such as the AAMC.
Finally, several years ago we launched a capital campaign to raise $1.5 billion dollars. This year we raised $270 million dollars, the largest total we have raised in any year in our history. We have about two years left in the campaign and we're at 85 percent of our goal. So we're thrilled that despite the economic challenges of today, people are still rallying to support this institution in a very significant way.
Q: How did you achieve these successes?
PS: We are very fortunate to have 23,000 very talented and dedicated employees led by a great group of chiefs and vice presidents. Those are the people who deserve all the credit for what I've mentioned to you, and then some.
The quality and dedication of the employees are something that I noticed when I first came here as a medical student in 1983. The people here feel [their work is] much more of a calling than a job. People here are incredibly dedicated to doing whatever is necessary to take the best possible care of patients, and I'm pleased that that spirit I first encountered seems to be very much alive and well. And that spirit is wanting to make a big difference in the lives of people we're caring for today and a bigger difference in the lives we will be caring for tomorrow and the next year and many years to come. That's the spirit of this place.
In 1810, there was a letter sent from two physicians to the wealthy people of the Boston area to support this new innovation called Mass General. The most famous line in that letter that received a very [positive] response is, "When in distress every man becomes our neighbor." That really captures, better than any other words, the spirit of this place — what it stands for and what draws people to work here. In most cases when they work here they never leave. About a week or two ago, we had an employee recognition event for people who've been here for 40 years or more and we had close to 1,000 people. Some people were celebrating 60 years on staff. There aren't many organizations that have that longevity of commitment of the workforce.
Q: How do you encourage this spirit?
PS: What I do personally is I try to celebrate that spirit and reinforce it as much as possible. Since I started almost nine years ago, I've sent out a monthly email to everybody who works here and I try as best I can to highlight things going on here recently. That reinforces the spirit. Also since I began about nine years ago, I keep positive letters from family members and patients who have had exceptional care here. At least once a month, I try to visit with the staff people who were mentioned in those letters and thank them personally for delivering great care. [We try to choose the] letters that are the most profound for us, the most special, and try to celebrate the accomplishments of the staff and the appreciation for staff's great care of patients. I look for every opportunity to reinforce this spirit in person or through more mass communications in the organization.
Q: What do you hope to accomplish in 2012?
PS: The most important thing, which has been the most important thing for almost 200 years, is to exceed the expectations of the 50,000 inpatients and 1.5 million outpatients we will be caring for next year. That is the first and second and third most important responsibility. It's not only why we're here and our purpose, but also the most important thing we can do from a business standpoint to be successful in the future. I also hope we continue to advance our other missions: research, education and community health. We need to continue the effort of turning this aircraft carrier, getting it well positioned for what is in all likelihood going to be a much leaner revenue picture than it's experienced in the past.
Q: What is the best piece of advice you can give to other hospital or health system presidents and CEOs?
PS: I've seen over the years many CEOs and other hospitals and health systems get so caught up in whatever the business challenge is of the day — forming a network, becoming an [accountable care organization], etc., — that they take their eye off the ball of day-to-day patient care and excelling in it. My most important piece of advice is don't take your eye off that ball, because not only is that ball what is at the core of what we do, but doing it well is in the long term the most important ingredient for success as a healthcare organization.
Q: What other insights on healthcare in 2012 can you share?
PS: I think we're entering into an era of unprecedented opportunity in healthcare. There are things going to come out of research that are truly extraordinary. At the same time we're facing economic circumstances which may make those things, and other things that are already delivered today, unaffordable. We're in for very challenging and interesting times ahead and I think the best way to get through all of that is if we in healthcare delivery can come up with lots of ways to make better and more efficient care and eliminate as much of the fat in the system as possible so we can afford the existing muscle and the muscle that's going to come out of the spectacular research in the future.
If we don't do that, if we don't innovate and improve care and make it more efficient, I'm fearful that we will be forced to cut into the muscle of healthcare here and across the country, and that would be a very sad state of affairs, not only for the people working in healthcare, but also for the American people.
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Q: What are the biggest challenges in the past year you have had to face as president?Dr. Slavin: One is specific to Mass General Hospital: We've been pretty capacity-constrained with limited inpatient beds, operating rooms and the emergency department. Managing the hospital at a time with a very high occupancy and congestion that is frustrating to a lot of people minimizes the opportunity to grow. Fortunately, a few months ago we began opening up a new clinical building that addresses a number of those capacity constraints, so that is making some progress towards addressing those challenges.
The other more broad [challenge] is that clearly as result of the economy and federal budget deficit and state budget deficit challenges, we as an organization need to make a transition from a fee-for-service environment to a more global payment environment and also an environment where rate increases are much more modest than what we've received in the past. How you turn this aircraft carrier around in a way that it can thrive and continue to [achieve] its mission in a new reimbursement environment has been a challenge, and it will be a challenge for many more years to come. On top of that, a significant portion of [our research budget] comes from the National Institutes of Health, and the budget for that federal agency is also quite challenged by the federal budget deficit.
Q: How did you overcome these challenges?
PS: In terms of financial challenges, we're doing reasonably well, but we decided this year to go through a budget review process to prepare for the future environment we're going to be living in in an effort to figure out how we can be more efficient and more affordable going forward. [This is] despite the fact that we are doing better than budget through most of the year — we trimmed expenses by about $40 million dollars a year in an effort to try to better position this organization for a much leaner reimbursement environment. Those efforts will continue this year and for the foreseeable future.
[In our] zero-based budgeting process, we asked all department heads to look at everything they're doing and identify things they could stop doing or things they could do more efficiently. Senior management and I met with department heads to go over their ideas, organizational charts and mission, and made some decisions about things we thought we could implement immediately. We also have a significantly larger pool of ideas that we're going to need some more work on to turn into reality.
The clinical building, which is called the Lunder Building, was designed a few years ago to address the capacity issues of not enough inpatient beds or operating rooms or a large enough emergency department. So, those three things make up most of the space in the new building. That building just opened a few months ago, and it is the largest and arguably nicest building we've ever constructed. And the staff that is now in there love being there and more importantly patients receiving care there are thrilled with the patient-centered aspects of the building. One of our doctors expressed concern that we might see the length of stay go up not because of any operational problems but because the patients might not want to leave.
Q: What were your greatest successes this past year?
PS: The new building would be one. [Also,] this is our bicentennial year — our 200th birthday since being established by the state of Massachusetts — and we had a number of activities going on throughout the year that celebrated that bicentennial. We focused not on celebrating the past, but looking forward on having a bigger impact in the next years than in the past 200. For example, we reenacted the signing of the charter on Beacon Hill. A couple years ago we commissioned a book on the history of the hospital that is now out and called Something in the Ether. And we've also this year given a significant gift to the community for the privilege of operating here in Boston in Massachusetts. We called it the Bicentennial Scholars program, and it's aimed at getting 26 high school students into college and through college in the next six years.
[A success] I would also point to this year is that we [were] awarded by the Association of American Medical Colleges the Spencer Foreman Award [for Outstanding Community Service], which is given to the hospital they think has the best community health program in the country. Mass General is renowned for clinical care, research and educational activities. It's nice to see those things recognized by an organization such as the AAMC.
Finally, several years ago we launched a capital campaign to raise $1.5 billion dollars. This year we raised $270 million dollars, the largest total we have raised in any year in our history. We have about two years left in the campaign and we're at 85 percent of our goal. So we're thrilled that despite the economic challenges of today, people are still rallying to support this institution in a very significant way.
Q: How did you achieve these successes?
PS: We are very fortunate to have 23,000 very talented and dedicated employees led by a great group of chiefs and vice presidents. Those are the people who deserve all the credit for what I've mentioned to you, and then some.
The quality and dedication of the employees are something that I noticed when I first came here as a medical student in 1983. The people here feel [their work is] much more of a calling than a job. People here are incredibly dedicated to doing whatever is necessary to take the best possible care of patients, and I'm pleased that that spirit I first encountered seems to be very much alive and well. And that spirit is wanting to make a big difference in the lives of people we're caring for today and a bigger difference in the lives we will be caring for tomorrow and the next year and many years to come. That's the spirit of this place.
In 1810, there was a letter sent from two physicians to the wealthy people of the Boston area to support this new innovation called Mass General. The most famous line in that letter that received a very [positive] response is, "When in distress every man becomes our neighbor." That really captures, better than any other words, the spirit of this place — what it stands for and what draws people to work here. In most cases when they work here they never leave. About a week or two ago, we had an employee recognition event for people who've been here for 40 years or more and we had close to 1,000 people. Some people were celebrating 60 years on staff. There aren't many organizations that have that longevity of commitment of the workforce.
Q: How do you encourage this spirit?
PS: What I do personally is I try to celebrate that spirit and reinforce it as much as possible. Since I started almost nine years ago, I've sent out a monthly email to everybody who works here and I try as best I can to highlight things going on here recently. That reinforces the spirit. Also since I began about nine years ago, I keep positive letters from family members and patients who have had exceptional care here. At least once a month, I try to visit with the staff people who were mentioned in those letters and thank them personally for delivering great care. [We try to choose the] letters that are the most profound for us, the most special, and try to celebrate the accomplishments of the staff and the appreciation for staff's great care of patients. I look for every opportunity to reinforce this spirit in person or through more mass communications in the organization.
Q: What do you hope to accomplish in 2012?
PS: The most important thing, which has been the most important thing for almost 200 years, is to exceed the expectations of the 50,000 inpatients and 1.5 million outpatients we will be caring for next year. That is the first and second and third most important responsibility. It's not only why we're here and our purpose, but also the most important thing we can do from a business standpoint to be successful in the future. I also hope we continue to advance our other missions: research, education and community health. We need to continue the effort of turning this aircraft carrier, getting it well positioned for what is in all likelihood going to be a much leaner revenue picture than it's experienced in the past.
Q: What is the best piece of advice you can give to other hospital or health system presidents and CEOs?
PS: I've seen over the years many CEOs and other hospitals and health systems get so caught up in whatever the business challenge is of the day — forming a network, becoming an [accountable care organization], etc., — that they take their eye off the ball of day-to-day patient care and excelling in it. My most important piece of advice is don't take your eye off that ball, because not only is that ball what is at the core of what we do, but doing it well is in the long term the most important ingredient for success as a healthcare organization.
Q: What other insights on healthcare in 2012 can you share?
PS: I think we're entering into an era of unprecedented opportunity in healthcare. There are things going to come out of research that are truly extraordinary. At the same time we're facing economic circumstances which may make those things, and other things that are already delivered today, unaffordable. We're in for very challenging and interesting times ahead and I think the best way to get through all of that is if we in healthcare delivery can come up with lots of ways to make better and more efficient care and eliminate as much of the fat in the system as possible so we can afford the existing muscle and the muscle that's going to come out of the spectacular research in the future.
If we don't do that, if we don't innovate and improve care and make it more efficient, I'm fearful that we will be forced to cut into the muscle of healthcare here and across the country, and that would be a very sad state of affairs, not only for the people working in healthcare, but also for the American people.
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