John Dubis has had to embrace a change mentality from the very first day he started at St. Elizabeth Healthcare. He had to lead the charge on a merger between St. Elizabeth and the old St. Luke Hospitals and now he has to implement the changes driven by health care reform as well as continue to grow the system.
Today, St. Elizabeth is a 7,300-employee $1 billion health care system and the ability to implement new initiatives in the industry is critical for the continued success of the system. Dubis, president and CEO, has been running hospitals for a long time. He has worked for academic medical centers, children’s hospitals, inner-city hospitals and large community hospitals and that experience is paying off.
“The good thing for us is because we have such a high-quality mantra, that has a natural tendency to be more creative and innovative,” Dubis says. “So our ability to see things differently, to take calculated risks, to be more innovative, we already have a culture like that.”
While the changes in the health care industry will alter how things have been done for quite some time, St. Elizabeth has prided itself on being one of the elite systems in the country. Looking for best practices, high-quality service initiatives and more efficient practices is what St. Elizabeth does best.
Here’s how John Dubis keeps St. Elizabeth Healthcare on the cutting edge of its industry by adapting to and accepting change.
Become more efficient
Since St. Elizabeth acquired the old St. Luke Hospital system, the health care system has been on a mission to improve operations and become more streamlined.
“Anytime you do a merger, you’ve got challenges,” Dubis says. “The good news is that the cultural fit of the two organizations was very good. Once we became one system, we were quickly able to take advantage of the commonalities that we had and take advantage of the opportunities to create more efficiencies and reinvest savings in more efficiencies and other new services that didn’t exist in this market.”
One of the ways Dubis and the folks at St. Elizabeth became more efficient was by consolidating services. The biggest example is the consolidation of its OB programs.
“At one of the former St. Luke Hospitals, they were delivering two babies a day and losing $3.5 million a year and at the other major St. Luke Hospital, they were delivering three babies a day and losing $3.5 million a year,” Dubis says. “We were losing $7 million a year on OB services. We decided to consolidate all the deliveries at the main hospital, the St. Elizabeth Edgewood campus, and by doing that we concentrated 5,000 deliveries in one place. We took the $7 million in annual savings and invested in redoing the entire OB service area physically from a floor perspective, and programmatically, we put in place a high-risk OB service, which this community never had.
“We were able to improve the quality of care rented to patients, we were able to improve the quality of care rented to premature kids, and we were able to save $7 million a year in the process. We took those dollars and started reinvesting into other clinical programs. So we really have enhanced the system overall and concentrating specialty needs in the right places that need to have them.”
It is critical in any business that you look to find areas where you can consolidate services or divisions to save money that can be put to better use.
“We wanted to eliminate unnecessary duplication of services which are costly, use those cost savings and expand the clinical programs in the community, both in terms of enhancing what we currently do and creating new services that didn’t exist,” he says. “That’s the focus that we have. Our mantra is quality. This organization learned many years ago that quality is the most important thing, not just for patient care, which is obviously our first priority, but also quality has shown to be good for business. It keeps you financially solvent and prospering because you’re able to do things in a more cost-effective high-quality manner and the resources that you get as a result of that goes into this cycle of upwardly investing and new and different activities for the patient’s well-being.”
The ability to reinvest is extremely important when trying to grow and improve any business. Health care reform is putting pressure on hospitals to make these types of improvements to enhance the system as a whole.
“There are really only two strategies that make sense in terms of dealing with that,” he says. “One is to grow your business, grow your volumes, and grow the market that you serve so you can get additional resources through that mechanism. Simultaneously and maybe even a little bit more importantly at this juncture, is beginning to be very cost efficient in terms of providing the services that you do provide, but in the same process not reducing the quality of what you’re doing. That may seem a little bit contradictory, but really it isn’t, because research has shown if you produce high-quality outcomes, patients tend to come to those types of organizations, which means your volumes tend to grow, which means you have additional financial resources that allow you to keep that reinvestment cycle going upward.”
Foster a change environment
While reinvestment is a very promising way to make business better, there is a lot of fear and anxiety by many about the future in the health care field. You have to make sure people feel at ease about the direction you’re going and it starts with your internal environment.
“The thing you have to do more than anything else is communicate, communicate, communicate,” Dubis says. “You have to make sure that everybody understands what the strategic goals of the organization are, that they’ve had a part in developing those goals, and to make sure that people are properly directed and rewarded for the achievement of those goals. By creating that level of constant communication and alignment of incentives and purpose, that’s how we’ve seen ourselves grow and develop and get better and better year after year.”
It’s never enough to just talk about it and assume things will get done. You have to work hard at forming that kind of environment and make sure you demonstrate it from the top of your business.
“It obviously doesn’t happen overnight, but there has to be a commitment at the top level from your board and senior leadership all the way down through the ranks of every employee in your organization,” he says. “There has to be a clear belief and clear example shown by the top echelon of the leadership ranks that the direction we’re going in is the right direction. You really have to get down to a lot of personal communication and a lot of personal involvement of employees in the process.”
Communicating direction is always critical, but it also takes involving employees in the process to help cement their understanding of new changes.
“They have to be part of the strategy and then they have to obviously be a key part of the solution,” he says. “They have to be part of developing the solution in terms of what they’re going to be responsible for and what they’re going to be held accountable for to make sure that we are achieving the goals that we have to achieve. It all comes back to constant communication from top to bottom and bottom to top. That’s what makes the alignment happen, the understanding happen and the teamwork happen to accomplish the goals that you set out to do.”
It’s easy to say just keep doing what you’re doing. However, if you have that mentality you won’t survive in any industry. You have to accept change.
“You have to be adaptable,” Dubis says. “You have to be able to assess your environment — whatever your environment may be — and make the changes and improvements that will best serve your customers that will utilize your facility. If you’re not adaptable, if you’re not open to change and innovation, you’re leading yourself down a road for bad things and potentially extinction or maybe being bought out by another system that can do it better.”
Develop change strategies
Leading through a period of change is a tough task. You have to make sure that you are heading down a path that your company agrees with and can understand.
“First of all, you have to explain what the situation is and then secondly, explain what strategies you want to employ that will ensure your ability to continue doing the things you want to do,” Dubis says. “You communicate the growth strategy, you communicate the efficiency strategy, and you communicate the consolidation strategy and make sure that people understand it’s not what’s good for one part of the system, it’s whatever affects one part of the system affects all of the system and creating the good for the whole is much better than the good for one organization.”
St. Elizabeth has been going through a number of changes over the past few years and more will be coming. Understanding where to start has been crucial.
“The first question we need to ask ourselves is what’s in the best interest of the patients and their families,” he says. “That is absolutely the most essential question. From there, we cascade down and figure out what are the resources needed, what are the barriers, what are the political issues, whatever they are. That is the first cut. We look at what’s the biggest impact we can make for the dollars we have available. We go through criteria starting with whether there are any safety issues that need to be addressed.
“Secondly, what are the enhancements or new services that are going to be of most benefit to the most number of patients? Thirdly, we get down to new clinical programs that we have determined the community has told us they want. Lastly, we look at replacing equipment that’s used for life. That’s the tree we go down in terms of prioritizing what we do.”
Planning your changes is an important part of being able to adapt to change easily and effectively. You have to understand where changes can have the biggest impact.
“You should set a decision criteria tree in terms of how you’re going to look at things,” Dubis says. “Secondly, you need to get broad-based input into that process. It can’t be something that’s done in my office or the chief operating officer’s office. It’s got to be something done in conjunction with literally the entire organization. You should be getting ideas from the ground level and looking to push that upwards so you can have those discussions. Then you need to provide a draft plan of what it is you want to do so that associates, managers and board members and all other interested constituents can have their say in terms of what makes best sense. Obviously, it’s management’s final call to make the decisions, but once you get that consensus built, it makes the process a whole lot simpler.”
However you go about your changes, you have to make sure you remain positive during the process.
“Don’t look at the glass half empty; look at it half full,” he says. “It’s easy to get negative and pessimistic about what’s going to happen in the future. I frankly look at it as an opportunity to lead ourselves in a different way that could be even better than what we have today. When people get negative about things and pessimistic, they tend not to be very creative or very innovative and that’s where I think the future lies for organizations that do those two things very well. This is not a time for the faint-hearted. This is a time for people who embrace changes and see this transformation we’re going through as an opportunity and not as a negative. This is a new world in which having a strong desire to embrace change and work within the abstract and uncomfortable zone of unfamiliarity is what it’s going to take to guide your organization to be successful down the road.”
HOW TO REACH: St. Elizabeth Healthcare, www.stelizabeth.com
Takeaways
– Find areas you can save money and become more efficient.
– Make change part of your culture.
– Develop strategies to decide how to implement the best changes.
The Dubis File
John Dubis
President and CEO
St. Elizabeth Healthcare
Born: St. Louis
Education: Graduated from Washington University in St. Louis and received his master’s in health administration from Washington University School of Medicine
What was your first job, and what did you learn from that experience?
My dad was a waiter, and when I was 12-years-old, I was 6 feet tall so I passed for 15 and I started working with my dad in the restaurants. What I learned from that is not only good organizational skills … but more importantly, I learned about the importance of customer service.
What is the best advice you’ve ever received?
Never give up. I learned in life you should never give up, because every day brings an opportunity to make something better. The only time that you can’t is the day that you don’t wake up. I believe that very much. If you really work through things and think things through, not only on your own but with a group of talented people, you usually can find solutions. You may have some failures or you may have some set backs, but if you keep pushing for the long term, usually you can do pretty well.
What do you see as the most important change hospitals are going through?
We’re going to have to become more customer focused in terms of dealing with our patients, creating a more positive patient experience both on the inpatient and the ambulatory side. The public is demanding that more and more. The other thing would be innovation. The ability to accept change and to make changes happen because the world will be different, and you have to develop new strategies and approaches and systems to deal with it.
If you could have a conversation with anyone, who would you speak with?
Jack Welch. I got to know Jack Welch through his first book and when I read it, the emphasis on the importance of having talented people in the organization and the process that they go through annually to do that, I thought was one of the best things I had heard on how to make your organization successful. He’d be someone I’d like to talk to and probe a little bit more into his thought process.
