How do you think Steve should coordinate communications in
How do you think Steve should coordinate communications in
Returning to his office after a meeting, Steve receives another fax listing many questions from one of the local newspapers pertaining to the potential consolidation of two hospitals in West Central Ohio. Steve, the new president and chief executive officer (CEO) of Upper Valley Medical Center, has been dealing with organized opposition from a group called Save Our Hospitals (SOH), numerous questions from newspapers, and has been caught in a communication whirlwind involving the consolidation. There had been discussions for several years about the possibility of a major acute care consolidation, long before the previous CEO left to pursue another opportunity. Through multiple strategic planning sessions and feasibility studies prepared by Ernst & Young, the future strategic direction for Upper Valley Medical Center was being critically evaluated. Upper Valley Medical Center is the nonprofit parent corporation that owned two acute care hospitals, one behavioral science hospital, three long-term care facilities, a for-profit insurance company, 11 medical office buildings, a home health agency, one free-standing dialysis center, and a corporation that employed physicians.
All of these entities are in Miami County, located in West Central Ohio. The population of Miami County was approximately 110,000 and the two acute care hospitals were located in the cities of Piqua and Troy. Both cities had a population of nearly 22,000, and they were the largest cities in the county. Piqua is located more to the north of the county and Troy located more to the south. The two hospitals served different markets. However, there was some competition in the north market and major competition in the south market, causing additional pressures on the hospitals. Hospital management and Ernst & Young considered all feasible alternatives with the final decision to construct a new hospital in the middle of the county. Of the possible alter- natives, the new hospital provided the best long-term financial viability option. The consol- idation of acute care services to one location was estimated to save more than $15 million annually in operating expenses. After thoroughly evaluating the possible alternatives, Steve believed the health system would not be viable in the long-term without the new hospital. The location would be five miles south of Piqua and five miles north of Troy. Upper Valley Medical Center owned approximately 140 acres of land at the new site.
At one time, there had been an acute care hospital at this location, but the acute care services had been discontinued and transferred to the hospitals in Piqua and Troy. The former acute care hospital was converted to business and administrative offices.The formal announcement of a new hospital led to a large public outcry as to why Up- per Valley Medical Center would want to close two apparently well-run hospitals and build a new facility in the middle of the county. City officials in Piqua and Troy had significant concerns over the plan. SOH opened two storefronts in Piqua and Troy to distribute infor- mation, most of which was inaccurate. To gain strength, SOH incorporated and sought funding through contributions. The primary funding source, however, came from a retired primary care physician who had a large following from his many patients and families he had served during his career. In addition, he was the current Miami County Coroner and was well known. His family had contributed significant dollars in previous years to the hospital in Troy. SOH created large signs and bright red bumper stickers that attracted much attention. The leadership of SOH contacted the State of Ohio Attorney General’s Office on a weekly basis in an attempt to get her to intervene and stop the plans for a new hospital. In addition, SOH contacted the local newspapers frequently to gain publicity. The two local newspa- pers, Piqua Daily Call and Troy Daily News, and one regional paper, Dayton Daily News, covered the story almost daily. Reporters at the papers routinely faxed multiple questions to the communications department at Upper Valley Medical Center.
Steve had multiple organizational constituents to consider in how he handled com- munications. Each constituent seemed to have an opinion of what should be communicated and how it should be delivered. In order to assist in handling the multiple communication issues, Steve formed a board of director’s Communication Committee. The members of the committee included Steve, the director of communications, and three trustees from the board of directors. The Communication’s Committee was authorized by the board of directors to provide oversight of communications, which helped to streamline the communications process. The primary constituents included 21 board of directors, 50 foundation board mem- bers, 250 medical staff members, 200 volunteers, 2000 employees, thousands of patients, and the general public. Before long, Steve was consumed in public relation issues and was spending nearly 50% of his time on communications. Most, if not all, responses be- came part of the public record, which added further complications in the certificate of need (CON) process. Moreover, SOH filed a lawsuit with the Miami County Common Pleas Court in an attempt to obtain a temporary and permanent injunction and a declaratory judg- ment against Upper Valley Medical Center in order to prevent it from moving forward with the plan to build a new hospital. In order to construct a new hospital, Upper Valley Medical Center was required by the State of Ohio to obtain approval of a CON. States require CONs in order to optimize the use of healthcare resources.
Hospitals subject to CON requirements must demonstrate a tangible healthcare need or other compelling justification in order to receive approval. A commu- nity’s input and desires also affect the outcome of CON requests.As the CON process unfolded, there were multiple public hearings. Each hearing was fairly contentious with many SOH members attending. The entity that was required to con- duct the hearings and make a recommendation to the State of Ohio was the Miami Valley Health Improvement Council (MVHIC). The CON law in Ohio had been changed a year earlier and essentially a positive recommendation from the MVHIC would result in the CON being approved by the director of health for the State of Ohio. If the MVHIC recom- mended denial of the CON, the director of health could still approve the CON although this would be very unlikely. There were many questions as to the financial feasibility of building a new hospital. SOH expressed their support for the existing hospitals and saw no reason to build a new fa- cility. Steve had facilitated evaluating the feasibility of maintaining both hospitals, closing either the hospital in Piqua or Troy and consolidating all operations to the other facility, or constructing a new hospital while closing the existing two facilities. The feasibility studies were very clear that the only likely viable long-term option was to build a new hospital. The primary reason was the belief that significant market share would be lost if one hospital was simply closed and operations were consolidated in the remaining hospital. Upper Valley Medical Center found itself on the front page of both local papers vir- tually every day along with being the subject of multiple letters to the editor.
All of the articles and letters were reviewed by the MVHIC as being relevant to the CON process. In fact, the MVHIC encouraged individuals concerns were ex- pressed about the additional distance people and ambulances would have to travel to a new facility. SOH members voiced concern that the additional distance would cost lives since it would take longer to get to the new hospital in emergency situations. addition, adding to the public discourse was the fact that the new hospital location was not within either municipality. Piqua and Troy would lose significant local income tax revenue, though some income tax revenue would flow back to the residences of the hospital employees. Despite the public opposition, Upper Valley Medical Center had many supporters. Ap- proximately 90% of practicing physicians supported the direction toward a new hospital and signed a petition indicating their support. Many individuals in the community wrote letters of support. However, SOH members were confrontational and boisterous, which resulted in many supporters preferring to keep a low profile. Many Upper Valley Medical Center employees removed their identification badges when in public for fear of being ac- costed by an SOH member. Typically in the CON process, the MVHIC would host the final hearing near the organization requesting a CON. Due to the public controversy throughout this process, however, MVHIC decided to move the final hearing to Miami Valley Hospital in Dayton, approximately 35 miles away from Miami County.
SOH chartered three large buses to bring nearly 200 members to attend the final hearing. Majority approval of the 22 MVHIC board members would be required to grant the CON. Steve realized that his success in handling the external, as well as the internal, communica- tion challenges would greatly affect whether Upper Valley Medical Center obtained CON approval. Without approval, the future viability of the health system was in jeopardy. How- ever, even with approval, the protests from SOH were not likely to go away anytime soon. SOH would clearly remain an adversarial constituent that would need to be addressed. Steve evaluated the optimal communication strategy for Upper Valley Medical Center. His approach had to be proactive as there was significant erroneous information being cir- culated by SOH. Steve recognized the importance of displaying confidence to the organization’s constituents and doing his best to dispel their concerns. However, he also recognized the challenge of needing to address each fax of questions he received daily from the local newspapers. Each question, no matter how insignificant it might appear, required a deci- sion. Should we respond? If so, how should we respond? Who should be involved in crafting a response?
Who should be informed of the response?1.How do you think Steve should coordinate communications in his role? Should there be different communication approaches for internal versus external constituencies? Should there be a different approach if Upper Valley Medical Center was a for-profit entity?2. Recognizing that all responses would likely become public information, how would this affect your approach?3. How would you manage communications in this scenario given the large number of stakeholders with various levels of knowledge and needs?4. Recognizing that to effectively address the communication issues would be very time-consuming, what if any organizational structure changes would you implement to enable you to have sufficient time?5. Knowing how emotional and volatile the situation is, as CEO how much of your time would you dedicate to handling the communications? Would believing that the new hospital is imperative to the long-term financial viability of the system affect your approach?6. If Upper Valley Medical Center receives CON approval, what should it do in the coming months/years to garner support recognizing that SOH members will likely never support the new hospital?CHAPTER 10: Communicating the Need for Hospital Consolidation Copyright 2015 Cengage Learning. All Rights Reserved.
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