By the time Tenet Healthcare acquired St. Mary’s Medical Center in 2001, the hospital had officially entered an identity crisis. In struggling to keep pace with industry changes, the West Palm Beach-based facility had floundered financially in its final years as a not-for-profit hospital. By the time Davide Carbone stepped in as CEO in 2006, St. Mary’s had become so unsure about how to move forward that it wasn’t moving at all.
“The hospital had a wonderful past and wonderful legacy and is a vital resource to the community, but it was treading water to figure out which direction to go in, in a world of constant change, especially in the health care universe,” Carbone says.
Despite coming in with a successful track record — Carbone spearheaded a major financial turnaround at Aventura Hospital and Medical Center as its former CEO — he had a big job ahead of him.
“The hospital had really not been advancing, had not been progressing, and people were concerned,” he says. “But they were also comfortable with what they were doing. One reason that the hospital wasn’t progressing or meeting the needs for growth was because they weren’t changing, and I became a change agent.”
Find an identity
To stabilize St. Mary’s financially, Carbone had to get its more than 1,600 employees and members of the community on board with some major changes needed to turn the hospital around. This was easier said than done.
“There was a large contingent in the community that easily wanted to see St. Mary’s go back to the old days that they remember fondly, but that was not practical,” Carbone says. “That’s not reality.”
Carbone needed to gain the support of the community and unite people around a new vision for St. Mary’s. The problem was that the hospital was perceived by community members in very different ways.
“This hospital had a glorious background and kind of fell into a trough and was having a hard time pulling itself out of it,” Carbone says. “It lives under the cloud of a lot of people’s impressions that we’re just a charity hospital or we’re just a trauma hospital or just a Catholic hospital.”
As a faith-based hospital, St. Mary’s is one of the highest providers of charity care in South Florida. It also functions as a level-one trauma center and a community hospital. Carbone wanted to show the community that St. Mary’s encompassed not one, but all of these things, and financially, it wasn’t a failing or destitute organization, but it had lots of potential and was still providing great services.
He decided the first step in re-establishing the hospital’s identity with the community was instituting a new logo that honored the legacy of the hospital while acting as a symbol for a fresh start.
“It seems trivial, but I think it gives people something to rally around,” Carbone says. “We all want to follow a leader. We want to follow success.
“In this case, it was just getting people motivated and getting them to see a vision of what could possibly be at St. Mary’s versus what had been at St. Mary’s.”
By getting the community excited about change and a new vision, people could start embracing change without feeling like they were abandoning the roots of St. Mary’s. Carbone refocused the hospital’s marketing and image-building efforts to generate excitement in the community about its goals.
He encouraged St. Mary’s staff to work proactively with the media. Giving the media more opportunities to learn about the hospital’s services and facilities, St. Mary’s began getting positive media attention instead of negative. This attention played a large part in renewing communication and building trust with community members, many of whom were Carbone’s biggest skeptics.
“Sometimes that criticism is legitimate and warranted, and sometimes it’s due to a lack of understanding,” Carbone says. “A lot of that is just communication.
“People have to see you as somebody they can trust and somebody you can believe in. As you develop that level of trust, people are much more willing to work with you and take risks with you.”
Getting the community on board with change was crucial. However, Carbone also had to make sure that employees were prepared for change at St. Mary’s. Having started in health care as a nurse’s aide and as an emergency medical technician, he knew how easy it is to get caught up in the hectic demands of the job and lose sight of the long-term vision. Many employees weren’t interested in changing the status quo, even with a negative company culture.
“It took a lot to convince some of the folks, especially on the medical staff, that change is a good thing,” Carbone says. “Change means change, but change also means progress and survival. You have to be a change agent, but you have to do it in the most positive way possible.”
In looking for ways to re-engage his employees, Carbone realized that one explanation for the alienation he saw was a lack of effective employee relations and recognition.
“One of the things I noticed right away was that we did very little in the world of employee relations,” he says. “We did very little communicating, very little celebration of our successes.”
Carbone had St. Mary’s human resources department bring on one person whose sole job would be handling employee relations and developing ways to call out the successes of employees and of the hospital.
With an employee relations department in place, St. Mary’s developed monthly employee newsletters, activities with employees and celebrations during the holidays. It started recognizing industry events, such as May’s hospital week, and being more active in charity events, including the Leukemia Walk and March of Dimes runs and walks.
The hospital has also developed awards for top employees and volunteers each quarter. By holding up these examples of success, Carbone hopes employees will see how each individual’s success benefits the hospital, which benefits everyone.
“You have to encourage people that it’s definitely teamwork,” Carbone says. “No one person, no one idea can save any facility. So you have to rally the leadership team. They have to rally the people that they work with to try to get on board and see we’re going in a new direction, and here’s the direction, and here’s why, and here’s what we need you to do to help us get there.”
Since Carbone stepped in as CEO, he hasn’t replaced one member of his senior leadership team at St. Mary’s, with the exception of a COO who left to become CEO of another hospital. By uniting the existing team to support change, he was able to build trust needed to move forward.
“Your job is to sell them your perspective, your vision and your goals and that you have the experience and wherewithal to make it happen if we can work as a team,” Carbone says.
Once you rally your people around change, you have to deliver it. Carbone was starting from scratch to develop a strategic plan that could turn St. Mary’s around financially and update it for the future. Before making any changes, he thought hard about St. Mary’s strengths, where it wanted to go, where it needed to be and how to get there.
“Those are all easy questions to ask but very difficult, especially in health care,” Carbone says. “There’s a lot of competition. Development of any service is very resource intensive, from equipment to supplies to personnel and to physicians. Changes are not easy to implement. Good ideas are not always easy to implement. So you have to prioritize what you think will have the biggest impact for the short-term and long-term success of the hospital.”
To grow, the hospital needed to maintain and enhance core programs, while developing others. That started with small steps, such as renovating and enhancing equipment and facilities. As Carbone examined opportunities to add new services, he looked at the services that St. Mary’s already offered and then considered how a new service could add to or enhance the existing services in a way that was successful for patients as well as the facility.
One way to do this was by providing people services locally that weren’t currently available. For instance, there was a lack of neurologists in the area willing to see patients in a hospital setting, and a lack of neurosurgeons willing to perform cranial surgery. Carbone worked to build a neuroscience team to supply these services at St. Mary’s.
He also led the drive to institute a pediatric open-heart cardiac surgery service and get it approved by the state. St. Mary’s is the first Florida hospital in 25 years to win approval for this cardiac service, which will be implemented this year.
St. Mary’s gets more than 3,000 transfers from other hospitals of people who are seeking its high-level services, so Carbone has dedicated much of his time to finding talented doctors and providing them with the resources needed to develop core services, such as pediatric, trauma, stroke and obstetrics.
“It’s very challenging for physicians in South Florida, but if we can provide them with the resources that they need and if they can see the same vision and opportunity that we do, then it’s a good match,” Carbone says. “If we can get them the right resources, they can build a successful program.”
Carbone brought on doctors to start a comprehensive stroke program, which opened in December 2008, and a physician to head a new limb orthopedic program, which brings in patients from around the world. He now constantly looks for ways to build out services that are not being met at all or not being met adequately to serve the community.
“All of our financial success has been built on building new programs, building better programs and making sure we’re meeting the needs of the patients that we serve,” Carbone says.
Build on success
By getting people to see how change benefits the community, the patients and the staff of St. Mary’s, Carbone has been able to transform the hospital into a growing and profitable facility. In 2010, St. Mary’s was elected business of the year by Palm Beach Chamber of Commerce and Carbone received South Florida Business Journal’s Healthcare Award for CEO of the Year. Each of its successes brings St. Mary’s closer to the next.
“Over time, as you build success stories and people see you are doing these changes for the right reasons, people get on board,” Carbone says. “Success breeds success. Bringing on good people brings on more good people. Having a successful service encourages others to take that same kind of risk to establish a new service.
“We’ve had major successes not only financially with the hospital, not only the development of services for our patients but also in the measurements of quality of the care we provide. Almost any measure you can measure, we’ve more than exceeded our goal.”
Infection rates have dramatically decreased in the last five years, and other core quality measures have improved. Financially, the hospital went from being in the red to being in the black. By building new programs and recruiting many new positions, St. Mary’s has increased its number of patients and employees, which has also benefited its local economy.
“A lot of skeptics in the community were taking a wait-and-see attitude to see where St. Mary’s was going to go,” Carbone says. “I think they’ve been pleasantly surprised that we’ve had a great deal of success in turning the facility around.
“That first year, year-and-a-half to two years is key to get a few success stories and get some energy into the facilities, environment and get people understanding that we are going to be moving in a new direction, but one that should be positive and beneficial to all of us. I think we’ve accomplished that, but you can’t sit back and be satisfied. You have to constantly be looking for the next opportunity.”
How to reach: St. Mary’s Medical Center, www.stmarysmc.com
The Carbone file
St. Mary’s Medical Center
Born: Boston area
Education: Bachelor’s degree in environmental biology from Clark University; master’s in health administration from Duke
What is your definition of success?
Being able to go home every day and feel you’ve done the best that you can for your facility or your employer and for your employees and to be proud of what you’ve achieved. … If you can go home at night and know you’ve done a good job, that’s probably the best measure of success. As long as you are gratified with the amount of effort that you put in and it’s actually leading to something that’s getting better and that you’ve hoped to achieve.
What do you like most about your current job?
The ability to make a change and make a difference in people’s lives, and that’s at every level, from the patients we serve, to our employees, to the folks out in the community.
If you weren’t doing your current job, what would you be doing?
There are lots of jobs I’d thought about early on through high school and in college, but I’m very happy doing what I’m doing and I can’t imagine doing anything else.