"I receive management reports, but you can't taste and feel the atmosphere from them," Evans says. "I also visit the volunteer in the surgery waiting room. She can tell me when it's been a good day."
One reason for his personal involvement is that when Evans officially assumed leadership of Clarian Health Partners Inc., a hospital system that includes Methodist Hospital, Indiana University Hospital and Riley Hospital for Children, the industry was wrought with distrust.
"My biggest challenge when I started was dealing with relationships that were strained and creating an environment of trust," says Evans. "I spent as much of my time with internal constituencies as I could, basically managing by walking around."
Evans assumed the top spot at Clarian in November 2002, after holding that position on an interim basis from July of the same year. But Clarian wasn't new to Evans, a former senior partner in the law firm Baker & Daniels and former chairman of the Federal Housing Finance Board. He has served on Clarian's board since the organization was formed in 1997, and was its chairman from 2000 to 2002.
The Clarian system that Evans oversees employs more than 11,000 people, operates more than 1,300 staffed beds and generates gross patient revenue in excess of $2 billion each year. The system dominates the Indianapolis-area marketplace, staking claim to a 31 percent market share.
Despite this, when Evans was named full-time CEO, he says he believed there was still a lot of work to do to both maintain and continue to grow Clarian.
"The industry itself is in a high state of change and tension," he says. "I knew we had to come together as a team and confront the tension. I reached out to the physicians and nurses and the rest of the staff to create an environment of trust. It is a continual process."
Drawing the road map
Karlene Kerfoot, Clarian's chief nursing executive, says its hasn't taken Evans long to put his stamp on the organization.
"Dan has a wonderful ability to get us all driving in the right direction," she says.
And she should know. As chief nursing executive, Kerfoot's been tackling one of Clarian's most difficult problems -- a shortage of nurses -- since 2001, when she adopted the AACN Synergy Model for Patient Care.
Kerfoot says one reason for the problem is that there are not enough nurses graduating from Indiana schools to supply the state's demand, and y, Clarian suffered because of it.
"We developed programs to become a magnet and attract nurses," Evans says. "We wanted to become an exciting place for nurses to work. It's all about patient care."
The Synergy Model matches patients' needs with the skill levels of their nurses. Patients who need more skilled care are matched with nurses who have those skills. Kerfoot says this allows the hospital to best utilize its existing resources.
"The system improves patient care, and both the patients and the nurses are happier," she says.
There are other benefits, says Evans. "There's no reason for them to leave," he says. "They (the nurses) work together as a team. It has made a difference to the work atmosphere and the patients."
In the three years since its initial implementation, the results have been impressive.
"Nursing turnover was 25 percent when Karlene started the program; now, it is 3 percent," Evans says.
That's important, says Evans, because Clarian employs more than 3,000 nurses, and high turnover quickly leads to increased recruiting and training costs.
But nursing turnover is not the only issue on Evans' plate. All three of Clarian's hospitals are located in downtown Indianapolis, and there are no other hospitals in the inner city.
"We have a high Medicaid population, a high number of charity care patients and a high trauma population," Evans says. "It is an intensely busy place."
Add to this an aging population that requires more services, and Evans says the result is a high demand for patient care.
"We're [patients] also not paying anymore for this care," Evans says. "That is the dichotomy at play. There are more services needed, but we're not paying for it."
To combat this growing trend, Evans is working with the board and his staff to develop new strategies for attracting more paying customers to the downtown hospitals.
"We are doing that by providing care that is second to none," he says. "That's our mantra."
One benefit in Clarian's favor is that it is the fourth largest transplant center in the United States. Explains Kerfoot, "We are a national draw for patients with transplant needs. The acuity of care gets higher and higher, and we provide highly sophisticated care. People want to come here because of that."
Even so, Clarian has also established a strong outreach program to extend its reach. The organization maintains working relationships with the Center for Occupational Health in Terre Haute, Decatur County Memorial Hospital in Greensburg, Dunlap Occupational Health Centers in Elkhart County, Rehabilitation Hospital in Indianapolis, Tipton County Memorial Hospital, Union Hospital Health Group in Terre Haute and West Central Community Hospital in Clinton, all of which help Clarian build its brand and diversify its client base.
None of the work, however, happens in a vacuum. If patients aren't happy with the care they receive, all of Evans' work will be for naught. So Clarian publishes its basic patient satisfaction number on its Web site so current and prospective patients can make educated decisions about where to receive care.
"You know more about your car than you do your doctor," Evans says. "We provide transparency so you can make a decision. We have a vision of being the best, but we also have the underlying facts to support it. And we put them in your hands."
The journey is underway
Clarian, says Evans, is an organization that constantly re-evaluates itself as part of its strategy of continuous improvement.
"Our main tactic is evidence-based health care," he says. "We are delivering the best care to patients based on science. All procedures are done differently. We have empowered the physicians with knowledge, and there is a lot of technology behind that."
Kerfoot says this technology includes embedded alerts in Clarian's computer system.
"When a patient is admitted, his or her chart is encoded with any special concerns, such as blood pressure," she says, adding, "It is impossible for nurses to remember everything."
A vital part of evidence-based care is research.
"Something like 20,000 medical journal articles are published each year," Evans says. "It's not possible for a physician to read them all. But our system gets an important article to a physician in real time when he or she needs it."
Another part of the strategy is to maximize efficiencies and get the most of Clarian's existing resources.
"We have a duty to husband our assets and drive out needless expense and waste," Evans says. "This means driving down incidents (mistakes in medication, etc.) and achieving the best results we can."
The final piece of Evans' strategic plan is to attract patients on a national level. Clarian is building a cancer hospital to leverage its strength in that treatment area.
"This is where Lance Armstrong was treated," Evans says. "And he found Clarian on his own."
Clarian is a leading breast cancer research center as well, and Evans says the plan calls for drawing more referrals from a broader region and, eventually, from across the nation. Currently, 65 percent of the hospital system's patients are residents of the Indianapolis nine-county region. Thirty percent come from the remaining 83 counties in the state, while only 5 percent come from outside Indiana.
Clarian is also building full service hospitals in two high-growth suburbs and cities near Indianapolis -- Carmel and Avon.
"Carmel is one of the top 10 growth counties in the country," says Evans.
Establishing full-service hospitals in these areas will help foster growth within the downtown hospitals, Evans says, because "there will be some patients that will need to be referred to the central hospitals."
While all of this is happening, Evans does not let long-range strategy divert his attention away from the personal needs of his staff or his patients.
"I visit a patient every day," he says. "I stay involved in the details. I am personally involved in the health care business." How to reach: Clarian Health Partners Inc., (317) 962-2000 or www.clarian.org