Five faces of Valley health care: behind the scenes of running one of the most complex businesses around: a modern hospital.

It's not a popular job, but somebody's got to do it: managing a hospital.

With under-funded state mandates, skyrocketing premiums and caring for the uninsured, it's a positron that faces unique and daunting challenges each day.

To gauge what's happening in today's local hospitals, the Business Journal brought together a group of five CEOs from facilities large and small: Beverly Gilmore, president and CEO of West Hills Hospital and Medical Center; Michael L. Wall, president of Northridge Hospital Medical Center; Heidi Lennartz, CEO of Mission Community Hospital in Panorama City; Kerry Carmody, administrator for Providence Holy Cross Medical Center in Mission Hills; Albert L. Greene, president and CEO of Valley Presbyterian Hospital in Van Nuys.

Most of the time, these executives are rivals, competing for the same nurses, doctors and, increasingly, patients. At the same time, they often deal with the same intricate issues--and face strikingly similar joys and struggles.

Q: This group probably has one of most complicated jobs in the country: managing a hospital. A lot of people wouldn't want to be in your position. But what's the best part? And what's the most challenging?

Beverly Gilmore, West Hills Hospital and Medical Center: You have to enjoy the people you work with. That's what gets you there every day. Whatever the challenges are, you know the people you work with can get through it.

I think the most challenging part is more challenges in California. The costs keep going up. That makes it challenging to survive and grow.

Mike Wall, Northridge Hospital Medical Center: I'll start with the best part. I think the best part is we're in a profession where we go to work and we make a difference. We have the potential to impact thousands of lives, whether it's life-in through our OB program, or whether it's dealing with the end stages of life. How we go about work is really fulfilling.

I think there (are many) challenging parts: the cost of technology and keeping current; the indigent care that you've got to provide coverage for; the physicians who are your customers and your competitors. There's just so much variety; you're never going to get bored.

Gilmore: That's actually one of the good things: never being bored. Everyday has issues you've never thought of. It's very varied what you do in a day.

Heidi Lennartz, Mission Community Hospital: And I think tangentially, you actually can experience the difference you make with the patients. Even as a CEO, you can go to that level with the patients and talk with them and see the difference that we can make on a day-to-day basis.

Q: Is there anything that would make your jobs easier day-to-day?

Wall: If they could teach us a class in graduate school in how to herd cats, it'd be good. (Laughs.)

Lennartz: It is like herding cats. You're balancing and trying to control and manage a variety of forces. And that's the art.

Q: A major issue facing local hospitals and the healthcare industry in general is the nursing shortage. There simply aren't enough nurses to meet state-mandated ratios. How are your hospitals dealing with that?

Kerry Carmody, Providence Health System: We're dealing with it through the Nurse Collaborative (a nursing education program at College of the Canyons in Valencia). We have not gone out to foreign countries to look for nurses, which has become more difficult.

There are a lot of nurses in the state of California. They just don't all want to work for us. So the idea is how to get them to work for the organizations represented here. And that's part of every one of our days.

It's the employee's choice because every employee--from housekeeping up through your pharmacists and your nurses--everyone's a free agent.

Anybody at Holy Cross can get a job the same day at any of the hospitals represented here. And people do. But you can't afford to lose those key individuals.

Albert L. Greene, Valley Presbyterian Hospital: I think a big part of the problem we have in the state is we're not graduating enough nurses. So one of the things we're doing at Valley Pres. is we're working with the local colleges to expand the programs. We've been working pretty closely with both Mission and Valley (community colleges) to assist them in expanding. We're paying for faculty. We're using our facility for training.

Twenty-five percent of all the nurses that are licensed in the state of California are not working anywhere. They're not working in a hospital or home care or nursing home. They're not engaged at all. (So we've) focused on ... those nurses who perhaps have been out of the profession raising a family for the last 10 to 20 years (and created) programs geared to bring them back to the workforce. Special residency programs to try to bring that 25 percent back into the workforce.

Q: As a lay person, it would seem sponsoring foreign nurses would be a logical way to go about reducing the nursing shortage. Is that correct?

Wall: I think there's things you have to consider. You have to consider culture. You have to consider competency. I think you want to consider the moral and ethical considerations. If nurses are scarce and we're taking nurses out of other countries or if there's over-supply that's one situation. But I think there are a whole host of questions.

Greene: First off, the federal government isn't making it easy. You've got to sponsor these nurses and from the day you sponsor till they show up could be several years. So it's a major investment. Very long lead time.

The problem that most of the public doesn't understand is a nurse isn't a nurse isn't a nurse. A nurse who works in critical care can't work in pediatrics. A nurse in pediatrics can't working the operating room. The OR nurse can't work the emergency room. The list goes on and on and on. So to try to project two to three years out (and say), "Gee, here comes a nurse that's a med-surg nurse, will I have that vacancy in med-surg? Maybe all my vacancies are in labor and delivery or OB or (pediatrics)," you can't project that far out.

It makes it very difficult to bring in foreign nurses because of the long lead time. And then, as Mike said, you've got the cultural issues. You've got language barriers.

Carmody: When you talk about education, at College of the Canyons--a tremendous nursing program that many of us are involved in with the Collaborative--I know somebody who's on the list to get into class. She's No. 340. So she's two, three years before being accepted into the program. It's a five-year wait to get into nursing school.

So we've created this tremendous demand every one of us. The average nursing salary coming right out school--we're all competitive--is around $48,000, $50,000 a year, plus benefits. So there's a lot of interest in becoming a nurse for all the right reasons. It's a calling. It's a career. It's flexible scheduling. It's all of those things. They just can't get in. And they're extremely frustrated.

Greene: And the problem with the universities is, even if they have the spots, they don't have the faculty. They don't have the trained people to do it.

Q: So if there are so many problems locally, why not import nurses? Do the risks still outweigh the benefits?

Wall: I don't think it's a quick fix solution. I think it's naive for people to think that will solve it. All of us in different ways are working to support the education process to get more (nurses) in the pipeline.

In the meantime, boy, you've got to hold onto the ones you've got. It's a highly competitive workplace where workload and those kind of things are factored, particularly here in the Valley. One-point-eight million people, 28 miles radius. People can move from institution to institution. They don't have to move their families. They don't have to do anything. Where other communities, you're talking about moving families. That's not the case here.

It's a very mobile workforce, very competitive and a great shortage.

Greene: The other problem is ... nursing is still dominantly a female profession. And what happens is, just by how society operates, women will enter a l0 to 20 year period when they raise kids (and) leave the job market either on a full-time basis or a part-time basis. It exacerbates the shortage. A big portion of their lifetime is not in the workforce but out raising kids.

Q: How is West Hills addressing the shortage?

Gilmore: I think we have multiple strategies. We do a little bit of all these things. We are looking at sponsoring some nurses from India. We do have scholarships for nurses at Pierce and Moorpark (colleges). We do specialized training for nurses that have been on our staff for a while and want to be specialized nurse.

I think all of us try every trick in the book. And usually, if you're all like we are, the turnover is in those nurses that are a year or two. And they're the ones that jump around. We've all got signing bonuses. It's hard for them to move around. Nurses that have been around awhile don't seem to move around.

We have travelers that come from other parts of the country. And they're very happy to come for three months. They can make here what they made there in a year. But they don't want to move here because of the costs.

Greene: The problem we have with the state is this is the only state with mandated staff nursing ratios for hospitals. And yet we rank No. 50 in the number of nurses per 1,000 population. So there's an absolute disconnect and the ratio and the availability of nurses.

Carmody: There's also a shortage of doctors. For all of us to be able to find the right physician is just as difficult as finding the right nurse. Because Southern California is the toughest market to recruit nurses to. They can do better outside the state of California both financially and lifestyle.

Greene: Also, in medical schools in this country, 50 percent of students are female, very different from when a number of us started in this business.

A lot of them will pull out of medicine for 10-15 years while they're raising kids. So you don't have the same accessibility and availability to physicians as a result of that.

Q: Beverly, we heard so much earlier this year about the labor issues at West Hills. It's all been resolved. How did that happen?

Gilmore: There has been a contract resolution, so we have a four-year contract now. But this is a relatively new labor contract with West Hills. Their first unionization was two years ago, part of a bigger contract that (Hospital Corp. of America, the owners of West Hills) and Service Employees International Union signed. So it's a new experience at West Hills.

That's another rather unique and intense challenge more so in California than other areas: we have pretty aggressive union organizations.

Wall: Let me show you how the markets move. We're in a collective bargaining agreement that includes the nurses. Usually when you're negotiating these contacts, you take into account the wage and salary, the competitive package at this time. In the Valley, things move so rapidly that in the middle of a contract our wages fell behind $1.7 million. So we had to make a decision: make a mid-course correction or losing those nurses, particularly the zero-to-five years.

Q: Is that the case at other facilities?

Greene: We're a non-union facility, but we operate basically as if we were a unionized facility. The market is so competitive that you've got to have wages and benefits that are competitive. It's also how you treat your employees.

Q: How does Mission operate?

Lennartz: Virtually the same way. Because we do share most of the staff in the Valley, they might get certain needs at other facilities they don't get at my facility. We're compelled to provide similar benefits.

But again, it comes down to a management issue. How we make ourselves available, our appeal system.

Q: How would you describe all of your management styles?

Carmody: I tend to be a people person, so I'm out and about. I've grown up in hospitals for 33 years, so I know a lot of people by name.

The style of management today is probably similar for everybody: you've got to be inclusive; you've got to bring your team; you've got to meet a consensus; and you've got to be successful with your medical staff. This is a skill set that the people in this room obviously have or they wouldn't be in the room.

Gilmore: You wouldn't last long, would you? (Laughs.)

Carmody: That's what makes the job a joy when it's working and a challenge to make it that way.

Greene: I think we all have to emulate that, but I think we would all say for us to be successful, our styles have to be eclectic. What works in one situation, one set of circumstances, one set of individuals, does not necessarily work everywhere. For those of us in this room, the reason whatever degree of success we've had is because we're able to read the situation and figure out what style is the best approach.

Gilmore: I don't think there really is a class in Hospital CEO. (Laughs.)

I don't think anyone would take it anyway.

You're right about how no one would want my job--I hear that three or four times a day. But you really develop a skill and experience and some confidence in that you're going to be able to look at each situation and come up with something that works. There has to be a lot of different strategies.

Wall: For me, it's really hiring the right people and getting out of their way. That's my management style. Al and I and Kerry and Bey, we've been doing this a long time. (Heidi is) the new kid on the block.

With the variety and the pace and the complexity of the job, you cannot stay on top of every thing unless you want to spend hours and hours and micromanage. So you've got to be a good judge of talent and have the ability to hire really good people.

Q: How do you get along with your boards?

Lennartz: I think what's important is to have a relationship with each individual board member and a relationship with their vision and helping them shape that vision, and the strategy and goals for the organization, both short-term and long-term.

I have been around situations where that didn't happen. And I think what can happen is that that vision starts to split apart. The CEO vision versus the board's vision. You all have to work to the same goal.

Q: Your board is an active board?

Lennartz: They have to be; we're a small, independent hospital.

Q: Are there any situations where you see a rubberstamp board?

Wall: That doesn't work either, because all of a sudden the pendulum swings and the rubber stamp board says, "We're listening to someone else. So we have to make a change. Goodbye."

Lennartz: I think they have a real sense of responsibility. As they should. They've been entrusted with this asset and they want to see it successful.

Carmody: For Providence in the Valley, we have a single board for both Holy Cross and St. Joseph's and really within the past three-four years the quality has been taken on. Lay people (have been) getting educated and working with the medical staff and setting targets for the management to hit and be accountable. That has really evolved. Before it was totally buildings and mortar. Now the quality is viewed just as important as finance.

Q: A lot of people are using emergency rooms as their primary care providers. How is that affecting how your hospitals operate?

Wall: Here's what you should be concerned about: You're gainfully employed (and have) wonderful insurance. Now you have a cardiac event. But we're on bypass (a designation, also called "diversion," when hospitals are too busy and cannot accept new patients and reroutes inbound ambulances to other facilities) because our emergency room is inundated with patients that should be at an alternative site. We can't take you.

Greene: They can't get to their primary care physician so they come to the ER.

In Los Angeles County, the average hospital is on diversion 216 hours a month. That's 10 days a month they're telling people, "We're jammed. Go someplace else."

Wall: Part B is getting physicians to cover the emergency room by specialty. Even if you pay, it's difficult.

Carmody: I also think there's a misunderstanding in the public about what the uninsured is.

The uninsured are a family of four making $40,000 a year, the husband and wife work and they don't get insurance from their company, they used to but it's no longer there. Or they get insurance but it's a $2,000 deductible plan, which means they come into the hospital and can't afford the first $2,000 it becomes charity care.

So these are good people; they're all working. That hits every hospital in this Valley.

Q: What do you see your jobs being like in 30 years?

Greene: I think we're going to find ourselves in a much more integrated role. Right now, the thing that differentiates American medicine is this separation of the physicians to the hospital. If we're going to deal with cost containment, if we're going to deal with quality issues, all of these have to be aligned and the only way you're going to do that is through some form of integrated system.

Carmody: If (the population of the San Fernando and Santa Clarita valleys are) 1.5, 1.8 million people right now, what are we going to do then? Nobody's building any new hospitals. We're already at capacity. So the discussion is, "What's the next step?"

Q: These are all complex issues.

Greene: But, you know, I can't think of a better career. Dealing with very bright people. You go home and say, "I made a difference." It's complex--you just heard all the issues. So it's an intellectual challenge. We're dealing with community boards and people who want to do the right thing.

I couldn't imagine doing anything else.

Carmody: You said earlier who would want to do this job. I can. There's a lot of people that would want my job. (Laughs.)

BY CHRIS COATES 

Staff Reporter