Healing the<BR>bottom line Featured

7:00pm EDT December 26, 2007

When William Moore arrived as the new CEO at Atlanta Medical Center in September 2001, he looked around and surveyed his new responsibility.

What he found was a hospital that had gone through an ownership change from a faith-based organization for the past 90 years to a for-profit, publicly traded company. The hospital was seeing declining numbers of patients in a competitive marketplace, and Moore was now the fourth CEO to lead the hospital in five years, which had created a credibility gap between the employees and leadership.

Things were bad and getting worse.

“The hospital felt like it was in the midst of a tailspin, and we had to correct that pretty quickly,” Moore says.

“Sometimes they’re very hard to pull out of. We hadn’t seen too much urban renewal at the time, so the area around the hospital was somewhat challenging or, at least, the perception of the area was challenging. We had, had some attrition of employees and medical staff, and I’m sure there were some jokes of who’s going to turn out the lights when the last one left. That was the challenge of taking it from a pessimistic attitude that things are not going well and the future looks gloomy to one of optimism and belief in the future.”

Despite the troubles it faced, Moore, who had previous experience with three other hospitals, thought AMC was the most capable one he had ever been associated with, and because it was a teaching hospital, he thought it offered a comprehensive array of services and had many opportunities. So he set out to evaluate the best opportunities that would pull the hospital out of its tailspin.

Evaluating opportunities

Moore met with his senior management team to identify opportunities that would rebuild not only the confidence of the organization but also its balance sheet.

“Although health care is unique in many ways, in some way, growing the business is the same as any other business,” Moore says. “You have to understand your community — what needs are out there for your customers, your community. You have to quickly gain an understanding of them and then meet those needs.”

Gaining that understanding means studying surveys, analyzing data and talking to them.

“Certainly you have to look at the demographics and whatever hard information is out there so you can understand objectively what’s going on,” Moore says. “I think you have to augment that with your instinct and your feel.”

In analyzing what AMC should do, he knew that focusing on several underserved specialties would be best.

“Not every hospital can be all things to all people,” Moore says. “Just like not every car rental agency can be Hertz, not everyone can be No. 1 in cardiac care.”

He says many hospitals were strong in the cardiac arena, so it didn’t make sense for AMC to chase after an already strong field.

“It’s a combination of looking at what makes sense from a competitive point of view, what needs exist in your community and what your hospital’s capable of.”

Moore says that it’s also important to not have too many priorities.

“It’s very difficult to be the best in class if everything is a high priority for you,” he says. “I’ve seen a lot of hospitals waste many resources trying to be a leader in a service line when it just was not feasible to do so.”

Between talking to community members and his experiences at other hospitals, some of the initiatives he felt AMC could capitalize on were strengthening its behavioral health services, committing to a trauma program and creating a bariatric surgery program. Behavioral health services was an area he had seen a great need for in his past positions and realized the hospital’s services were simply underutilized. Trauma made sense because of the center being a teaching hospital and the fact that many centers were pulling resources out of the area. And bariatrics made sense because of the onset of the obesity epidemic.

“Identify those issues and then go about providing those services to meet those needs,” Moore says. “It’s pretty simple in that respect — understand the needs of your constituents and then meeting those needs.”

From those initiatives though, he had to decide what to prioritize and do first.

“Part of it is the low-hanging fruit,” Moore says. “What could we do? What was the most immediate opportunity? What could we do the quickest?”

When Moore looked at the initiatives he wanted to implement, the bariatric surgery program seemed the easiest because he already had surgeons who were interested in performing the surgery, so it was simply a matter of buying the equipment needed.

“You spend some time in strategy sessions and getting feedback from your different constituencies, but once you get some consensus, and if you rely on your instincts, then you have to switch quickly to execution,” Moore says.

Communicating changes

Despite how obvious the need for the new initiatives seemed to Moore, not everyone agreed.

He met this resistance by opening the lines of communication with people who were interested and anybody who was questioning the changes. He pointed out the facts, including the growing obesity epidemic and the benefits the surgery offers, including how it reduces diabetes.

“Just through continuous and open dialogue, people, if they have an open mind, at least understand,” Moore says. “My philosophy is to share as much information with stakeholders as possible because I believe that if they have the same information as I have, most of the time, they’ll come to the same conclusion.”

This communication strategy also became crucial in dispelling myths people believed because of what past leadership had told them. When Moore learned that someone told the nurses — who account for nearly half of the 1,900-person work force — that there would be across-the-board raises, he had to be the bearer of bad news.

“It wasn’t good news for those that were expecting it, but over time, it brought a lot of credibility and respect because we didn’t dance around the issue, and we didn’t pretend to be doing something that we couldn’t do,” Moore says.

“Leaders can’t cop out. They can’t take the easy way out. I think sometimes people have a tendency to send their second in command or someone else to deliver the bad news, and I don’t think that works. If it’s important news, then I think the highest-ranking person should not be above delivering that and should not be above the fray, so I do think that, that is a key.”

He says that if you fail to communicate bad news — or news that employees could perceive as bad — yourself, your communication efforts in general will fail in the long run because people need to feel they trust you, and if they don’t, they’ll never believe anything you say.

“We try very hard to always be honest and direct, and that will gain you credibility over time and get buy-in from folks,” Moore says.

While it’s important to communicate that bad news, you also have to share good news with employees, as well.

“People need hope, so if things are starting to come together, and you’re not good at communicating that, a lot of folks won’t know that anything’s changed,” Moore says. “If they’ve been in a period of turmoil, and turnover might be high, or they might be out looking at other opportunities, they’re going to continue to do that. I think it’s important and in an organization’s self-interest to communicate progress whenever they have the opportunity to do so.”

As some of the early initiatives started to fall in place, Moore communicated the progress to people and he could see attitudes starting to change.

“You could just feel the sense of optimism returning and the camaraderie,” Moore says.

“People go from looking out for themselves to enjoying the collective experience and starting to be proud of being at the hospital that they’re at. That’s certainly something you want to have. Some of it’s palpable. You can sense it in the eye contact when you’re walking the halls and the smiles and the overall spirit.”

While Moore could feel the good vibes rising as the turnaround progressed, he also saw it in the cold, hard facts — employee, patient and physician satisfaction survey scores all increased, as well.

“It’s very important to get buy-in,” Moore says. “No. 1 in our case was to show a win, and then always be truthful in the communications and direct and honest, and that helped overcome the credibility gap that might have existed here.”

The more he narrows that gap, the better the hospital grows. When he first started, the hospital had 11,600 inpatient admissions, and since then, that number has grown to 15,000 last year. On top of that, revenue has grown from $150 million in 2001 to $237 million in 2006. As a result of the growth, he’s been able to add about 190 jobs, as well. Despite the changes, Moore keeps looking for incremental improvements instead of focusing on grandiose, long-term plans.

“I focus more on the things that are fundamentally true all the time, and that is if you are delivering great customer service, then that is going to be a long-term plan,” Moore says. “If you will create a culture where there’s a perceptible difference when somebody walks into your institution between your institution and another institution, then that’s a long-term plan. If the employees here are comfortable bringing their loved ones to that facility, that is our long-term plan.”

But no matter what the challenges are, tell people what’s going on.

“Be open and honest with what needs to be done, with where you are,” Moore says. “You don’t have to panic people. A turnaround situation is touch and go. You don’t want to emphasize how bad it is, but you don’t want to hide things, so be open and honest about where the organization is and what may need to be done to get to stability and growth after that.

“That’s first and foremost. Then execution. When you’re in a turnaround situation, this is not the time for tremendous emphasis on long-term strategic planning and vision creation. That’s the time for execution for what you need to do today to get you till tomorrow.”

While leading a major turnaround isn’t an easy task, Moore points out that the hardest tasks are the most worthwhile.

“It’s always going to be challenging, but the more challenging it is, the more rewarding.”

HOW TO REACH: Atlanta Medical Center, (404) 265-4000 or www.atlantamedcenter.com