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The Honolulu Advertiser
Posted on: Monday, May 21, 2007

COMMENTARY
HMC offers formula to quality patient care

By Dr. Danelo Canete

Much has been written about the sad state of Hawai'i's medical care system. In recent months, the news has included the near financial failure of Kahuku Hospital, low ratings for Hawai'i hospitals in a national healthcare study, the flight to the Mainland of physicians in high-risk specialties, a long and bitter nurses' strike on Kaua'i, and a growing shortage of physicians on the Big Island that has led to severely diminished levels of care.

From the headlines, you may think Hawai'i Medical Center (HMC) is part of this bleak picture. When HMC took over the former St. Francis Hospitals early this year, those hospitals were close to bankruptcy. It was necessary to immediately restructure our workforce and take other steps to avoid further fiscal deterioration, but the Teamsters Union challenged the resulting layoffs. An arbitrator found HMC was in compliance with our purchase agreement for the hospitals and confirmed our right to restructure HMC's workforce. But, at the same time, he found that our contract with the Teamsters required us to rehire some of the laid off employees.

Then, the Legislature rejected HMC's request for temporary tax relief while we nurse our hospitals to financial health. A major cause of our fiscal problems is that almost seven out of 10 of our patients are uninsured or on Medicaid or Medicare — more than any other hospital on O'ahu — and reimbursements for their care do not cover the cost of their treatment. We thought a two-year reprieve from the state excise tax would be justified and in the public interest. However, the Legislature turned us down.

With all the bad news, it may appear that HMC is in a tough position. However, while significant financial challenges remain, I am most optimistic that HMC will continue to move forward to become a key piece of the solution to Hawai'i's healthcare puzzle.

Why am I so confident in the face of such adversity? Two reasons: physician ownership and a nurse-centered treatment model.

Physician ownership is a resurgent trend in the hospital industry because it aligns the ethical and professional interests of ownership with the doctors who provide medical care within the hospital.

When physicians own a hospital, quality becomes the paramount value, because by training and temperament, a doctor's overriding commitment is to the well-being of his or her patients. HMC is the largest physician-owned hospital in the United States.

Our commitment to quality has led HMC to empower nurses in the treatment process. Given appropriate authority and responsibility, nurses become key players in meeting the highest standards of patient care. HMC is steadily increasing our ratio of nurses to patients and increasing their say in the treatment process, an approach proven to produce better patient outcomes.

Hospitals are reimbursed flat amounts for treating particular diagnoses by public and private insurance, so, when patients get well more quickly, the cost of their care is reduced and the hospital makes a profit.

Expressed as an equation, this formula looks something like this: Physician owners' commitment to their patients plus empowered nurses equals superior patient outcomes, equals financial stability.

We are already beginning to see positive results from this shift in our care model.

Doctors who are invested in a local hospital will be less likely to leave for the Mainland. And empowerment of nurses will help us attract the best talent at a time when there is a shortage of nurses.

HMC shall overcome the challenges it faces to set a new standard of medical excellence for Hawai'i's hospitals and become financially sound. We shall:

  • Enhance and expand HMC West in 'Ewa into a full-service hospital second to none, thereby filling a tremendous need in burgeoning West O'ahu.

  • Continue our leading role in transplantation at HMC East and transform it into a state-of-the-art facility.

  • Become the hospital-of-choice for physicians who seek to work the very best facilities, and for patients who want the very best medical care.

    We understand we will be judged according to our actions, not our words. We are confident we will pass the test and make an important contribution to solving Hawai'i's healthcare crisis.

    Dr. Danelo Canete is chief executive officer of Hawai'i Medical Center.