Three years later, the Dayton region’s only medical facility dedicated to children is in the midst of a major building boom, including the new 260,000-square-foot, eight-story patient tower and a $47.5 million expansion of the hospital’s Springboro campus announced earlier this month. The new facilities will help the hospital compete with bigger children’s hospitals in Columbus and Cincinnati and better accommodate the needs of the more than 290,000 children and families from 20 Ohio counties and eastern Indiana that the hospital serves annually.
The hospital’s growth follows its strategic plan, Destination 2020, a reflection of Feldman’s vision for future growth while remaining true to the hospital’s original mission of providing the highest quality pediatric care to all children, regardless of a family’s ability to pay.
Feldman, who as county administrator championed many community initiatives — including the county’s efforts to end homelessness, the Montgomery County Healthcare Safety Net Task Force and the establishment of the Community Health Centers of Greater Dayton — sat down with the Dayton Daily News to discuss her second act as a hospital administrator and the factors influencing the hospital’s competitive strategy.
Q. What led you to consider the switch to health care after decades in county government?
A. I loved what I did. But as time goes on you begin to think maybe there is another opportunity out there. I knew I wanted to continue to do something that was mission driven. As I began to think about what was next, and the opportunity here at Dayton Children's opened up. I thought it would be a great opportunity to take what I learned at the county and direct it specifically at children's health. I had some background because at the county I had worked with the hospital systems, and I worked with the two prior CEOs of Dayton Children's and was familiar with Medicaid, which, of course, is a very big payer for children's hospitals. I also spent a lot of nights in my study at home reading and learning everything I possibly could about health care in general, and about children's health care in particular. Sometimes, you are just really lucky, and, in my case, I was really lucky to have this opportunity at Dayton Children's.
Q. What was the first thing you wanted to do after you took the job?
A. My first priority was to get to know the people who were making Dayton Children's the very, very special place that it is. I had a great advantage at the county because I had been there since I was 23 years old. I knew everyone. I think a really important aspect of any leadership role is for people to get to know you as an individual, and a person, not just as the CEO or county administrator, and also for me to get to know them, not just what their position is, but who they are as people, their families, where they live, what's important to them. I spent a lot of time trying to get to know people, and first and foremost among the people I wanted to get to know was our physicians. I spent a lot of time talking to our physicians.
Q. Once you established a rapport with hospital’s doctors, staff and other stakeholders, what was your next move?
A. To try to formulate in my mind where we should go as an organization. After talking to literally hundreds of people, I came away with some pretty clear conclusions. The first among those was that there were a huge number of people who were very talented and cared deeply about children's health and wanted to make sure that Dayton Children's remained strong and completed its mission of improving the health status of kids. I also came away with the knowledge that everything about health care was changing, and it was changing at an incredibly rapid pace. If we wanted to continue to succeed and continue to play the role in children's health that we had in the past, we had to move quickly, and we had to evolve. It's all changing, so we wanted to make sure we understood the future as well as understood the great things about our past, and that's how we developed Destination 2020.
Q. What are the core principles of Destination 2020, and what was the impetus behind the plan?
A. Our plan is very rooted in data, market data about how we deliver care, where we deliver care, who's delivering care, and how we get paid for delivering care. We looked at our financial resources, and we began to make sure that we were putting our money where it needed to be. And then we looked at our physical resources, and, frankly, that's where we were significantly falling short. The average age of our inpatient space was 40 years, which is really ancient when it comes to health care. We knew if we were going to continue to stay true to the reason we existed…we could not continue to be that great children's hospital if we did not upgrade our facilities. They just wouldn't support the care our physicians needed to provide.
Q. Can you elaborate?
A. Well one of the main things we needed was private rooms. The fact is that rarely do children spend the night here alone. So when you don't have a private room, when you're sharing a double room, you're talking about two children and at least two parents in the same room. That certainly doesn't support the experience that our families deserve, but it also doesn't enable us to control infection as well as we'd like, it doesn't enable us to control the environment or provide the privacy that our patients want and deserve. Additionally, we needed to ensure that our facilities could support the health care equipment and technology of the future. For all those reasons we had to upgrade our facilities.
Q. How has health care reform under the Affordable Car Act impacted your competitive strategy?
A. We continue to see a lot of changes come down the pipe that are driven by the Affordable Care Act, such as movement from payment (Medicaid and Medicare reimbursements) for volume to payment for value. That is something the health care law is pushing very strongly as well as cost-effectiveness. Every hospital in the country is working very hard to bring down their cost structure so they can be affordable to families. One of the things we're most proud of is that we're one of the most cost-effective children's hospitals in the state of Ohio and probably across the country. We call it value creation here. The question is how do we create value by having lower costs and higher quality.
Q. Can you give me an example?
A. A great example of that is that we now have pharmacists in our emergency department. In the past families would come in and get a prescription and might not get it filled right away because some of our families don't have pharmacies right down the street like many of us have, and they may not even understand how to utilize the prescription correctly. With a pharmacist right in our emergency department, the pharmacist can dispense that prescription on the spot, and they can give really good counseling on how best to use that prescription. In that way, we've been able to keep our costs lower but also been able to raise the quality and utilization of the prescription. (Note: The federal government's 340B Drug Discount Program requires drug manufacturers to provide outpatient drugs to eligible health care organizations at reduced prices)
Q. How is Dayton Children’s different from adult hospitals, and what are some of the unique challenges you face going forward?
A. What some folks don't realize is that we are primarily a specialty hospital. If you're coming to Dayton Children's for a doctor's appointment, you're coming for the most part to see who we would call a pediatric sub-specialist. They might be a pediatric cardiologist or a pediatric endocrinologist. Also, most of our parents are young parents in their 20s and 30s, and many of them are tech savvy. So we're working very hard to catch up with them because we know what they're looking for. Some of the projects that we have on our drawing board are online scheduling, so that parents can schedule themselves, and texting reminders for appointments. These are all things that we're working very hard right now to put in place. We think they will help with adherence to appointments and prescription renewals and other things that our important to prevent re-admissions. We approach health care here from a family standpoint, and anywhere that we can include the parent and the child in their care plan, we think there's a much better chance of avoiding re-admission.
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