An Interview with John Day and Ronald Goodspeed, MD

When John Day and Ron Goodspeed sat down to talk about forming the organization now known as Southcoast Health System, they barely knew each other even though the hospitals they led were only about 20 minutes apart.

Ronald B. Goodspeed, MD, MPH, FACP, FACPE, President, Southcoast Hospitals Group, and John B. Day, President & CEO, Southcoast Health System.

What they did know was the world of health care was changing.

Many community hospitals were partnering with larger, tertiary health systems in the interest of survival and losing the ability to respond to the specific needs of their communities.

Both Day and Dr. Goodspeed were determined not to allow their hospitals to follow that route. The alliance they forged not only kept the focus of the new Southcoast Health System on the distinct needs of the region and brought unprecedented health care to southeastern Massachusetts, it introduced the concept of regionalization to the area, which has fostered alliances that reach far beyond the realm of health care.

What was the vision for Southcoast when the two of you first sat down to talk about the hospitals coming together?

Day: The health care marketplace was changing at the time and many hospitals were looking to join up with larger organizations and academic medical centers. Ron and I were of the same mind, but we felt that merging with a larger hospital or group would cause us to lose our focus on our communities. We both wanted to explore the option of developing a local, regional system that could respond to the specific needs of the communities we served.

Dr. Goodspeed: Both Charlton and St. Luke's were good hospitals in good financial condition. John and I talked about a joining of equals — a collaboration that would increase both quality and access to care.

How did Tobey become involved?

Dr. Goodspeed: At the time, Tobey was struggling and purchasing some services from St. Luke's to help hold down costs. John Carlson, who was the CEO at Tobey at the time, approached John about the hospital joining with St. Luke's. The talks between St. Luke's and Tobey happened separately, but simultaneously, with the talks between St. Luke's and Charlton. We did it that way so that in case either deal fell through it wouldn't scuttle the other.

Other health system and hospital mergers have struggled. What is the key to Southcoast's success?

Dr. Goodspeed: We created one, joined parent company — Southcoast Health System — and one, joined hospitals group with three sites. That meant one balance sheet, one strategic plan, one management team and one set of boards. There would be no competition between the hospitals that made up the group — that was different from most other mergers.

Day: Most hospital mergers appended the business models that were already in place. We built an infrastructure that eliminated any "we/they" situations. It was always "us" from the very beginning — one voice, one vision, one direction. The behavior of our Board of Trustees was also integral. Trustees were able to transition from thinking of the legacy institutions to acting for the overall benefit of Southcoast.

Do you feel Southcoast has made a significant impact on the health care of area residents?

Dr. Goodspeed: Yes, absolutely. I think we have made an incredible impact on our region. We have dedicated an enormous amount of resources to the creation and re-creation of state-of-the-art facilities, the development of services that might not be here otherwise, on quality care and patient safety and on building a reputation as a top-notch provider.

Day: Not only have we made a significant impact on health care in our region, we used a business model that has kept us strong and therefore able to continue the more than 100-year-old legacy of health care in the region. There is no danger of us going away.

From the outset, you have said that employees are the heart of Southcoast. How has that thinking evolved over the past decade?

Day: That ideal was true of our legacy institutions and continues to be true today. Our employees are the heart and soul of our organization. They have embraced the Southcoast culture and helped to make us the excellent institution we are today.

Dr. Goodspeed: At the core of providing excellent health care is people taking care of people. That is what it's all about. All the technology in the world isn't going to help you if you don't have great people at the bedside and behind the scenes. Southcoast has those people. If you look at our balance sheet you will find the majority of our expenses are related to our employees. They are the critical piece in all of this.

What do you think is the most significant change in health care in the past 10 years?

Day: I think there are three to consider. The advancements in technology and pharmaceuticals; the complexity of how caregivers are paid for the services they provide, and the increasingly competitive nature of the health care industry.

Dr. Goodspeed: Certainly the rapid advances in technology are among the most significant. Our ability to help people live longer and with a better quality of life is nothing short of remarkable. But with those capabilities come the equally impressive cost of technology and the crisis in health care financing and the increase in uninsured patients.

The rapid growth of health care provided outside of the hospital setting is also significant. Hospitals have their quality and safety overseen by organizations like the Massachusetts Department of Public Health and the Joint Commission on Accreditation of Healthcare Organizations. Care provided outside of the hospital setting does not have the benefit of that oversight.

Health care consumers have access to more information and data than ever. How do you think that has changed how health care is delivered?

Day: The Internet gives people access to a tremendous amount of information of varying degrees of quality. Access to good quality information that is easily understandable is going to be very important because people are going to need that knowledge to make decisions about their health care.

Dr. Goodspeed: I firmly believe in the concept of providing as much information as possible to patients and their families so that they can make good decisions about health care. But that is very difficult to do. It is almost a one-on-one process.

There is so much information out there for patients to look at, but it isn't always presented in a way that patients can understand and, therefore, use. We need to work to make the information that is available more understandable and usable to the average person.

What are the biggest challenges facing health care both in Massachusetts and nationally?

Dr. Goodspeed: Certainly the question of health care financing and the fact that there is no comprehensive health care policy. There are partial policies and partial state policies but no unified vision or strategy.

Day: At Southcoast, we do not turn any patient away so we become the insurer and provider of last resort, and that is a challenge for us. People are concerned about the rising cost of health care but they also want the best care available. As technology advances, the whole health care system feels extreme pressure to cover the cost of providing that care. We have to be realistic about what is available and what is appropriate.

Another challenge is finding qualified and trained staff to fulfill the needs we have. We are lucky to have an outstanding staff that is dedicated to our culture and to the communities we serve.

How is Southcoast addressing those challenges?

Day: I firmly believe that increased quality of care leads to a decrease in cost of care — and everything we do bears that out. We have to continue to focus on providing the highest quality care possible.

Dr. Goodspeed: We are constantly working to find resources to pay for health care, whether it be through negotiating with third-party payors or working in government affairs to effect legislation or increasing our philanthropic support.

We also continually look for ways to lower costs and, as John said, the best way we can lower costs is to deliver high-quality care. High-quality care brings about shorter lengths of stay — it prevents nosocomial infections, ventilator-associated pneumonia, infections at incision sites and a host of other preventable complications. Preventing these issues lowers the cost of health care.

What can employees do to help?

Day: Employees can help — and do help every day — by delivering the best quality care possible. They can continue to embrace our cultural elements of integrity, trust and openness, adaptability and flexibility, and effectiveness and efficiency to deliver the best care possible in the best manner possible.

Dr. Goodspeed: Keep patient and employee safety top of mind all the time. Provide the best quality health care possible. Take care of every patient as if they are the most important person in your life.

Southcoast depends upon philanthropic support from all sectors of the community to provide vital services to Southcoast patients. Why is that support important and has it become more or less important over the years?

Day: Our hospitals are a community resource and need to be supported to ensure that resource continues to be available for all those who need it. Just as our legacy institutions were supported by loyal benefactors, so is Southcoast. The recent renovations at Tobey received significant support from the community. The same thing is happening at St. Luke's right now. The Fall River community supports Charlton. The Charlton Trust has provided tremendous support to the cardiac surgery program.

Dr. Goodspeed: It is also important to include volunteers, employees and physicians when we talk about support of the hospital. We are dependent upon and appreciative of all those who provide all kinds of support.

You have had to make a lot of decisions in the past 10 years. Are there any decisions you would have changed?

Dr. Goodspeed: Making mistakes is a fact of life when you are in leadership, but I don't think I would change any of my decisions. I always do the best I can to make the best decision possible. When I make mistakes. I acknowledge them, apologize for them and learn from them.

Day: Like Ron, I know that we have learned from decisions along the way and that we have always made the best decisions possible under the circumstances at the time. We have always taken the decisions we have made very seriously and made them very carefully and deliberately.

What is Southcoast's vision for the next 10 years?

Day: We have to remain committed to our mission so that people do not have to leave the area to receive the care they need. We need to make sure that the services our patients need are right here in their own communities. There will be changes to the way health care is provided and we need to remain flexible so that we can adjust to those changes, just as the founding fathers of our legacy institutions adjusted to the changes in health care more than 100 years ago. We want to be here for our communities for another 100 years — and more.

Dr. Goodspeed: We need to continue growing as a high-quality organization and increase access to high-quality care and higher capabilities. We need to find ways to become a regional referral center. There will be no improvement in the crisis in health care financing, so we will have to be constantly creative in providing increased access to that high-quality care. We also need to help create a greater transparency in terms of getting health care information to people and in helping them understand the flood of information that comes at them.

When you think of all that has been accomplished in such a short time — a decade — what makes you most proud?

Day: I am not really the kind of person who stops to smell the roses. As soon as we have accomplished something, I am ready to move on to the next challenge. But I have to say the formation of Southcoast is a great source of pride for many reasons. Our model was successful and everyone involved embraced what we did. We introduced the concept of regionalization in southeastern Massachusetts — before we created Southcoast, each community functioned independently and did not consider the advantages of operating as a region. The joining of our three hospitals was the catalyst for that thinking in the area.

Dr. Goodspeed: I, too, am still most proud of the fact that we had the courage and foresight to bring Charlton, St. Luke's and Tobey together with a unified vision and mission. It has made such a difference in health care in our communities and in the lives of everyone who lives here. That decision made the rest of what we have accomplished possible.