Conversations
A Conversation with John Singerling, President of Palmetto Health
MidlandsBiz:
Talk about the scope of Palmetto Health.
John Singerling:
The leadership of our sponsoring organizations, Baptist Healthcare System of South Carolina and Richland Memorial Hospital, had the foresight nearly seventeen years ago (1995) to recognize that healthcare in our region is fragmented, and that by combining the missions and expertise of the two largest healthcare providers in the Midlands, we would have the opportunity to serve our community in a more comprehensive way.
Today, Palmetto Health is the region's largest, most comprehensive, locally owned, not-for-profit health care resource. We lead the region in the number and volume of inpatient and outpatient services provided because of the depth and breadth of available services including general, acute and critical care; the number and diversity of specialty physicians providing a full array of treatment from primary to emergency care and beyond; care that is delivered with compassion by a staff that achieves high levels of satisfaction in their work, patient satisfaction, patient safety and quality outcomes.
A lot of people think of our hospitals when they hear the words Palmetto Health, but we really are a geographically dispersed healthcare system comprised of an array of services across the health continuum, from ambulatory services (primary and specialty physician practices, urgent care centers, outpatient surgery, imaging and lab services, and an impressive list of community partnerships) to multiple acute-care hospitals (Palmetto Health Baptist, Palmetto Health Richland, Palmetto Health Children's Hospital, Palmetto Health Heart Hospital, Palmetto Health Richland Springs, and, in December 2013, the opening of Palmetto Health Baptist Parkridge) and post-acute services such as homecare and hospice.
Our annual revenues are approximately $1.3 billion and, as a not-for-profit healthcare system, we operate on a lean net operating income margin (generally between 2 and3 percent ) – which is reinvested into our program and service offerings. On average, we care for more than 830 inpatients per day in our hospitals and treat more than 1,600 people per day in our outpatient locations and emergency departments. We have more than 8,000 associates on our team and 1,000 physicians on our medical staff. As healthcare reform takes hold and physicians align with health systems to provide a more integrated experience for our patients, we are expanding our employed physician network. We now employ nearly 170 physicians and are affiliated with more than 200 clinical faculty physicians through our strong partnership with the USC School of Medicine.
Another major part of our success is our Foundation, the Palmetto Health Foundation. One of the ways we can continue to offer an array of services targeted to meet specific community needs is through their extraordinary work. Through capturing community support, the Foundation is essential to us maintaining a level of excellence with new programs, services and equipment.
There are only four Level I trauma centers in the state, one of which is at Palmetto Health Richland. We offer the only comprehensive pediatric services in the Midlands through our Children's Hospital and deliver the majority of behavioral health services for our region. Since we do not provide burn or transplant services, we stabilize those patients and work with other healthcare providers to ensure they get the care they need.
Because Palmetto Health is a not-for-profit health care system, our mission is to serve all people regardless of their ability to pay. We reinvest every dollar that we generate above our costs into the services we deliver to our community.
MidlandsBiz:
The scope of Palmetto Health will change with the addition of the Palmetto Health Baptist Parkridge campus that is currently under construction in the Northwest quadrant of the city. Talk about the Parkridge campus and the challenges of building a new hospital.
John Singerling:
Ten years ago, we looked at the geographic footprint for Palmetto Health and decided we needed to dramatically expand our services to the citizens of the Northwest quadrant of the Midlands. We submitted a CON (certificate of need) through DHEC and our hospital plan was finally approved in 2006. We intend to deliver an extraordinary patient experience on our new Parkridge campus and are looking forward to our opening in December 2013.
MidlandsBiz:
How much will the project cost and how are you financing it?
John Singerling:
It will cost more than $100 million to build our hospital. Given the low interest rate financial market, it made the most sense for us to finance this project through the issuance of debt. We do, however, have a very solid balance sheet to support our continued growth and expansion in the future.
MidlandsBiz:
When will Palmetto Health Parkridge open and how many beds will it be? What services will be offered there?
John Singerling:
We are excited to be opening as a 76-bed hospital with plans to expand to 250 to 300 beds, depending on the needs of the community in the future. There will be 400 people working in the Parkridge hospital initially, about 250 of whom will be new employees to the system. Next year, we will begin a thorough recruitment process to hire those employees.
We already have master planned the entire campus including ambulatory (outpatient) services. Our 75-acre campus provides the flexibility to expand as needed in the future. Parkridge will have emergency services, medical and surgical inpatient units, an intensive care unit, a labor and delivery unit and a newborn nursery, four operating rooms, outpatient care and diagnostic and treatment services including laboratory, imaging, pharmacy and more. One of the advantages of being a large system is the ability to offer seamless service to our patients in an integrated fashion. As such, we do not intend to duplicate certain high-specialty services currently offered in our larger downtown facilities such as open heart surgery, trauma care, and Gamma Knife radiosurgery. For these services, we will stabilize our patients and provide rapid transfer from Parkridge to our other facilities as needed.
MidlandsBiz:
What can people expect from the new hospital? What opportunities do you see by being able to build a new hospital from scratch?
John Singerling:
Compared to expanding or upgrading a facility that is 50 or 60 years old, building a new hospital in a green field is really a dream come true. We want this hospital to be a model – a learning lab of sorts. The building will be beautiful. Improving the patient and family experience, however, is more important to us than the bricks and mortar. Our true opportunity is to combine our historical perspective with a vision of how a hospital of the future should function to meet the needs of our patients and their families. We are able to look at everything as our customers do–from ease of parking, to signage, to how patients enter, navigate through, and depart from our hospital.
Another big opportunity is to incorporate the latest in technology infrastructure needed to create a paperless hospital with improved communication between all caregivers and functional areas. In addition, we have taken the opportunity to study industries outside of healthcare to see how they are intentionally creating personalized and memorable experiences for those they serve. Many of the principles we have learned from those experience exemplars can and should be applied to the healthcare industry, and we intend to incorporate them across all of Palmetto Health, including Parkridge.
MidlandsBiz:
How do you manage such a complex organization in a time of such uncertainty about the future of health care?
John Singerling:
Healthcare is one of the most complicated industries on the planet, and there is a lot of uncertainty about the future in the marketplace today. The burning platform of the Great Recession highlighted our industry's need to address the unsustainable rise in healthcare costs. If you project current trends, by 2035, all government tax revenues will be consumed by interest on debt payments, Medicare and Medicaid, and Social Security alone. Clearly, we must transform our country's fragmented system and be passionately committed to the long-term vision of managing people's health. As a result, hospitals feel as though they have their feet in two different canoes. In the future, hospitals will have less revenue and a higher number of patients to serve through the expansion of Medicaid and the Affordable Care Act.
The biggest strategic question in healthcare is how to rein in costs while still improving the patient experience, clinical quality and the health of the people we serve. How Palmetto Health answers that question is critical to our future. We are improving the patient experience by engaging and motivating our incredibly skilled workforce to come to work every day, to deliver the care and compassion we would want for our families and ourselves. We are reducing our costs by becoming as efficient as possible, by being smart and eliminating unnecessary variations across our organization.
The economic system that has driven healthcare for decades has been built around one key metric: volume. Increase your volume so your revenue covers your costs. Going forward, healthcare providers are going to be paid based on outcomes and quality of care, not just volume. Our mindset has to shift from caring for sick people in hospitals to keeping people healthy and out of hospital—or, as it is known in the industry, population health management. Effective care may be best delivered in outpatient facilities and not in hospitals. The healthcare system of the future must operate much differently than it does today.
MidlandsBiz:
Where can you reduce costs?
John Singerling:
Disciplined and data-driven methodologies such as Six Sigma have proven very effective at improving business processes in a wide variety of industries. We need to continue to apply those to the healthcare industry in a more robust and comprehensive way.
Many healthcare systems are extremely fragmented in their structure, with functional areas operating in silos. At Palmetto Health, we are now operating as one organization, regardless of geographic campus.
Previously, we had a person at each hospital managing the operating rooms, for example. Now, we have one leader in charge of operating rooms at all of our campuses. Similarly, the emergency rooms all report to one executive. This streamlining of the organization has allowed us to deliver services in a more effective and consistent manner. In addition, 20 percent of the money spent on healthcare in this country is spent on treating the people who are readmitted to the hospital within 30 days. We are deploying innovative strategies to provide more effective, proactive care management and coordination that keeps them healthier and, therefore, out of the hospital.
MidlandsBiz:
Will bigger be better in the healthcare delivery models of the future? Will we move towards mega-healthcare systems?
John Singerling:
We have seen bankruptcies in the smaller community hospitals in our region including Bamberg and Barnwell counties. I think we are going to see consolidation in the next three to four years in the healthcare industry overall. On the flip side, we have seen the government and the Federal Trade Commission trying to restrict monopolization. Officially, in January 2014many more of the provisions in the Affordable Care Act will kick in which will only add to the pressure felt by healthcare providers. We are truly in a time of great opportunity and transformation in our industry, and the next few years are going to be very challenging and exciting.
MidlandsBiz:
Where are you at in terms of your strategic planning process?
John Singerling:
Strategic planning for us is an evolutionary and ongoing process. Under the leadership of Chuck Beaman, our CEO, we established a 10-year destination strategy and core set of principles. We then broke down our 10-year strategy into three-year increments to give us the best opportunity to stay the course while being mindful of the changing environment. From there we set our annual goals while also performing very routine check-ins of our current performance against our long-term destination strategy. We also established our six-pillar organizational performance framework – People, Service, Quality, Growth, Finance, Growth, and Community– and started aggressively tracking our progress toward goals in each of these areas.
But our cultural transformation really began back in 2007, when we created a new vision statement for our organization: "To be remembered by each patient as providing the care and compassion that we want for our families and for ourselves." This vision has galvanized our organization with the appropriate focus on serving everyone the way we would want our families or ourselves to be served. In addition, we established standards of behavior for all 8,000 employees in the organization and we hold them accountable to those standards. Top performers want to work in a high-performing environment with high expectations and accountability systems. In addition, we believe we must partner and engage with physicians in a more meaningful way. One of the strategies we've unveiled is the establishment of an innovative program called the Palmetto Health Quality Collaborative with 450 doctors in our community joining to improve clinical quality and reduce costs for our patients.
The result of these strategies and initiatives has been transformational for Palmetto Health. Our clinical quality outcomes skyrocketed. We improved our employee engagement from the 26th percentile to the 91st percentile, exceeding our targeted goal by year three. We have been picked as one of the top 100 places to work in America for healthcare, four years in a row. It's been an awesome journey. We now have industry people coming to Columbia, South Carolina to learn from Palmetto Health.
MidlandsBiz:
Talk about your background and how you ended up at Palmetto Health.
John Singerling:
I was born in Florida, and raised in Michigan. Healthcare has been my passion since I was in high school. I did my undergraduate studies at Michigan State University.
I have a love of sports and decided to become a certified athletic trainer while at Michigan State. My goal was to use my athletic training background to obtain a scholarship for graduate school. After completing an internship with the Indianapolis Colts, I was fortunate to be offered a scholarship and came to Columbia in 1994 to pursue my masters in Health Administration degree while working as a graduate assistant athletic trainer with the Carolina football team. Seventeen years ago, I met Chuck Beaman. He gave me a 90-day commitment to come on board to complete my post-graduate fellowship. Fortunately, I am still here today. It is an honor to work alongside Chuck, our extraordinary leadership team, and the thousands of dedicated people who comprise Palmetto Health.
MidlandsBiz:
What is your current role at Palmetto Health?
John Singerling:
I have been President of Palmetto Health since October 2010. Prior to that, I was COO of Palmetto Health Richland. I am tasked with operational responsibility for the health system under the leadership of our CEO.
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