CCH PennMed

Published: Synapse 2013, Vol. 3

This one question has driven all decisions at Chester County Hospital since its founding in 1892. It's not about what's best for the bottom line, the leaders, the physicians or staff -- although these are important -- but what's best for the people of Chester County and surrounding areas. For 120 years, the answer was clear: The hospital could best serve the community as an independent, stand-alone organization, building the programs and culture most suited to local needs.

Michael J. DuncanMichael J. Duncan

Within the past several years, however, standing alone has started to impede the hospital's mission to the community. After the 2008 U.S. financial crisis, it became more difficult to access capital needed to finance new facilities and equipment, as lenders gravitated toward much larger health care systems and organizations. With the arrival of President and CEO Michael J. Duncan in 2011, the hospital conducted a thorough review of all facilities and technology and concluded it would take well over 200 million dollars to create a truly leading edge facility within 10 years -- and it expects nothing less than to be leading edge.

"Hospitals are capitally intensive places," Duncan observes. "To bring in a new technology like robotic equipment for surgery, you need two million dollars. If you need a new wing, we are talking about 50 or even 100 million dollars. Chester County was among the top 10 percent of hospitals nationwide in terms of our quality metrics and patient satisfaction, but we did not have access to capital to build what this community needs."

At the same time, hospital leaders realized there was a major shift taking place in health care, with more specialty services and outpatient procedures moving into community settings. More patients were staying closer to home for surgeries and other treatments that once required traveling to a major academic medical center. Increasingly, only the most complex cases would have to be sent to Philadelphia, says William Wylie, Jr., Chairman of the Hospital Board of Directors.

WylieWilliam Wylie, Jr.

In this changing environment, how could the hospital keep advancing its facilities and technology while broadening its scope of services? How could it keep doing what is best for the community?

By 2012, the Board and leadership arrived at a new answer: partnership -- and not just with any partner, but with an organization that would complement its strengths, help it better fulfill its mission to the community, and respect the culture it had worked so hard to build. After an intensive year-long search, the hospital found the right partner in its own backyard: Penn Medicine. In September, the two organizations announced that Chester County Hospital will be the system's fourth hospital, joining the Hospital of the University of Pennsylvania, Penn Presbyterian Medical Center, and Pennsylvania Hospital.

"We have the strongest reputation as a community hospital in Chester County, and Penn has an incredibly strong national and international reputation," says Mike Duncan. "Putting those two together is very powerful."

In August 2012, Chester County Hospital's Board of Directors issued a nationwide call for applications from potential strategic partners. A committee formed to solicit interest from roughly 30 different health systems, corporations and health care organizations. The committee then asked for detailed proposals from a group of 16, deliberately including a wide range of candidates: for-profit and nonprofit, regional and national, religious and non-religious, academic and community- based. By casting such a wide net, says Duncan, the Board and leadership team were able to explore many different options and refine their thinking about what would be best for the community.

"We knew we had objectively great quality, market-leading patient satisfaction, a great community, and that we were going into the discussions from a position of strength," he says. Duncan also had a clear understanding of what physicians, staff and employees wanted in a partner, thanks to a series of a dozen or more town hall meetings during which he and other committee members asked for input and answered questions about the process.

"Everybody wanted the same thing: a partner who would let the culture thrive but give us access to capital and programs. We would still be us, only better. So this became the main item on the checklist we used to evaluate candidates." The committee chose five finalists to make detailed presentations about what a relationship with Chester County Hospital might look like.

Throughout the process, Penn Medicine emerged as the most natural fit for Chester County Hospital. Many of the two organizations' administrators and physicians already had working relationships or had trained together, so their first meetings were more like reunions than blind dates. The hospital had existing clinical affiliations with Penn Medicine in high-risk Maternal-Fetal Medicine, Radiology and Cancer. Patients needing higher level care often went to see specialists at one of Penn's hospitals downtown. But most importantly, it became clear that Penn Medicine wanted to empower the hospital to do what's best for this community.

"Penn was head and shoulders above everyone else because they want us to be more than we are today, and they are willing to invest more in our facility and technology and bring in new clinical programs," Duncan says. "They were appreciative of our existing culture and they wanted a relationship where the local management team would be responding to the needs of the local community."

OkalaPhil Okala

"We are approaching this integration just like a partnership," notes Phil Okala, senior vice president of business development at Penn Medicine. "Chester County Hospital has a rich culture and sense of stability that was attractive, and they understood the value of Penn Medicine. To have a venture be successful, it is vital to have the organizational cultures and leadership aligned."

At the same time, Penn Medicine realized the value that Chester County Hospital would bring to its organization. As more services shift from urban medical centers to suburban settings, it too must adjust to a changing health care environment. Through its Clinical Care Associates network of primary care and specialty practices and the more recently formed Penn Specialty Network, Penn Medicine is already bringing high-level medical services to the Route 202 corridor and Chester County -- just one recent example being the new Penn Medicine Valley Forge facility. With Chester County Hospital as a part of Penn Medicine, the health system can offer the western suburb residents access to a wider range of medical procedures right here, only bringing a patient downtown when the case is complex enough to warrant the attention of a highly specialized team.

O'MalleyBert O'Malley, MD

"Our goal isn't to duplicate everything in the community," says Bert O'Malley, Jr., MD, chair of the Department of Otorhinolaryngology/Head & Neck Surgery and associate vice president, Physician Network Development. "Working with Chester County Hospital, our goal is to provide high-quality care across a wider breadth of disciplines so patients don't have to come downtown to Penn. But we also want to work together to define when it does make sense for a patient to come here, and then create clear and efficient pathways for them to access the highest level of advanced care when they need it. Potentially, someone might come to Penn for a specific complex procedure and then return to Chester County Hospital for their follow-up care or rehabilitation. That's how smooth we want the transitions to be."

BargRonald Barg, MD

Ronald Barg, MD, executive director of the Clinical Care Associates network and an internal medicine physician with Penn Medicine Bala Cynwyd, agrees that a seamless transition is key.

"The overall goal is to develop a health care delivery system that allows patients to get seamless care, and the more we can link up, the better," he says. "We already have several primary care practices in the Chester County Hospital area, so this is a great opportunity to develop the community reach for Penn Medicine and bring more services to the hospital.

"Coordination is better for us and for the patient," he adds. "In my own practice, if I see someone in Bala Cynwyd and I need to send him to a specialist at HUP [the Hospital of the University of Pennsylvania], we share the same information in the electronic medical record and that's so much more effective. Is the eventual goal to bring Chester County Hospital into that? Absolutely."

You may have already noticed that Chester County Hospital has added the Penn Medicine name and logo to its signs, web site and advertisements -- but the impact will be much broader than just a name change.

In the near term, you'll notice what Michael Duncan calls "an acceleration of everything we need to do for the community." First up is the completion of the final two floors of the Lasko Tower, a capital dependent project. In January 2014, a new orthopaedics unit will open on the third floor, followed in May by the new maternity unit and nursery on the second floor. This will provide the flexibility the hospital needs to start turning semi-private rooms into predominantly private rooms, which has been a longstanding goal. Renovations to the operating suites and upgrades of technology and equipment are also on the priority list. Throughout the hospital, it will be in a much better position to invest in the best that medicine has to offer.

Over time, you'll also notice more physicians with Penn credentials bringing a wider range of clinical services to this community.

"Let's say a patient here needs a specific type of lung surgery," Duncan explains. "With Penn Medicine, we would be able to have a discussion with a faculty member that specializes in thoracic surgery or thoracic oncology, and have that physician come and see patients here. This is just one example, but it shows how the partnership can broaden our clinical offering."

Duncan adds that he and other hospital leaders have already met with leaders of the cardiovascular programs at HUP, Pennsylvania Hospital, and Penn Presbyterian Medical Center to figure out how to expand services at Chester County Hospital. The same conversations will take place "medical specialty by medical specialty," he says.

Chester County Hospital has a mixture of employed and private practice physicians on its Medical Staff - a model that has worked well for the hospital, the doctors and the community. As new programs are developed, you may notice a wider range of specialty services available to meet the needs of this community.

In addition to accessing more services closer to home, Chester County families will benefit from the commitment to innovation and excellence that Penn Medicine brings as a recognized leader in academic medicine. Chester County Hospital's physicians, nurses and clinical staff will have access to continued professional education through Penn. At the same time, the hospital will be in a better position to recruit new physicians from Penn's training programs.

If you or a family member needs to be seen downtown at Penn, you will be moving within the Penn system and your physicians can better facilitate the connection. In the case of a life-threatening emergency, that quick and seamless transfer is especially critical.

"As we move forward, we are focused on the idea that a rising tide floats all boats," says Phil Okala of Penn Medicine. "We must strengthen the Chester County Hospital brand while adding value to the overall Penn Medicine family -- all in a very thoughtful way. We think that Chester County Hospital will be the top-notch hospital in the region, growing even stronger locally and also when needed, be able to provide for a seamless transition to a more specialized level of care in Philadelphia that cannot be accessed locally."

What will not change here is the culture that so many patients and staff say they appreciate so much, whatever words they use to describe it: "family-oriented," "friendly," "a close community," "familiar faces," "neighborly," "attentive," "caring," "felt like I was my nurses' only patient" . . . and the list goes on. This culture has been in the making for 120-plus years, and it will remain an essential part of the fabric of Chester County Hospital for the next 120.

By Kristine M. Conner

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