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Lois Skillings, president and CEO of Mid Coast Health Services in Brunswick, has a ready answer for anyone curious about what it's like to be a health care leader at a time when so many changes are happening. First and foremost is the Affordable Care Act of 2010, the most sweeping overhaul of the U.S. health care system since the passage of Medicare and Medicaid in 1965. But there's also payment reform, expensive investments in electronic medical recordkeeping and an accelerating shift away from treating people who are sick to making sure they stay healthy by providing care that's proactive, timely and appropriate to their needs.
“The train is moving down the track and the train track is being laid just ahead of it,” she says.
But as a self-described optimist who relishes tough challenges, Skillings says the sometimes-overlooked benefit of rapid change, whether in health care or any other arena, is that it requires action — instead of passive acceptance of current conditions. And if there's anything that virtually everyone agrees on, she says, it's that health care in the United States is too costly, often fails to deliver the best possible care and cannot possibly be sustained in its present form.
“What we're trying to do [at Mid Coast Health Services] is part of the broader transformation of our health care system,” she says. “That is a philosophical and foundational belief of our leadership team. We believe in the transformation. We don't long for the good ol' days. We believe that it is necessary to fundamentally change health care and that it's our generation's work to make sure it happens.”
Those aren't empty words, either. Since July 2011, when Skillings succeeded Herb Paris, Mid Coast's longtime CEO and president, Mid Coast Hospital has consistently earned straight As for patient safety (the highest score possible) in the Leapfrog Group's twice-a-year national and state rankings. It also has earned the gold seal of approval from the Joint Commission, an independent nonprofit that has been evaluating hospitals for safety and quality of care for more than 50 years, after being named one of 11 “Top Performer” Maine hospitals by the commission in 2012. And, in its most recent recognition, U.S. News & World Report recognized Mid Coast Hospital in July as a “Best Regional Hospital” for 2015-16 — making it one of 137 hospitals nationwide and just two in Maine (the other being Maine Medical Center in Portland) recognized in the magazine's 26th annual “best hospitals” list.
A registered nurse by training, Skillings also is proud of the American Nurses Credentialing Center's 2009 recognition of Mid Coast as a “Magnet” facility for its “exceptional nursing and patient care.” She was the hospital's vice president of nursing and patient care at the time and notes the honor is bestowed on fewer than 7% of the country's hospitals. All those accomplishments and others, she adds, have been achieved at costs 25% to 30% below the state average.
Skillings credits Bath Iron Works, and the former Brunswick Naval Air Station before it closed in June 2011, as key stakeholders whose need to control their overall health costs have helped the hospital pay closer attention to its costs. The lesson learned, she says, is that reforming health care isn't solely the burden of providers; it's everyone's responsibility. And, as important as controlling costs really is, she is quick to affirm “care” as the overarching value of Mid Coast Health Services.
“I don't see health care as a business,” she says. “It is truly a service. We have to run it like a business, but we have to do it, and improve it, for the community.”
Skillings credits her participation in the Robert Wood Johnson Foundation's Executive Nurse Fellows program with giving her the skills and confidence to assume the top leadership position of a health care system — a system with a 92-bed acute care hospital, 1,800 employees and $136 million in revenue.
There were 20 nurses in her 2008 cohort and only 222 who've participated in the program since its creation in 1998. A key part of the leadership training, she says, involved picking a project that would challenge her leadership skills and tackle a significant health care problem facing her hometown community.
“The organization was undergoing a transition of leadership from Herb Paris to me,” she says. “So I decided to take on a big project. I said, 'Let's redefine our big strategic vision.' That's what made sense to me, given all the significant changes happening in health care … the Affordable Care Act being an obvious one.”
Skillings and her colleagues organized a series of community meetings, inviting residents, business leaders and health providers from 30 communities in the hospital's service area to share their ideas about the future of health care in mid-coast region. More than 1,000 people participated. The resulting document, approved by Mid Coast's governing board in February 2011, is called “2020 Vision.” It lays out a comprehensive road map for improvement, with five overarching goals for the decade-long initiative.
“The 2020 Vision really guides all our strategic efforts,” Skillings says, noting that the long-range plan is broken down into two-year increments, with specific projects, benchmarks and timelines to ensure accountability and to keep the momentum going. “It boils down to the Triple Aim — getting better health, better care and better costs. It helps us prioritize and ensures that everyone gets behind what we're going to be working on for each two-year period.”
Midway through the 2014-16 strategic plan, Skillings can check off two projects identified as essential components of achieving the plan's goal of improving primary care — the opening of two new primary care practices, one in Topsham and the other in Bath, at a combined cost of $11 million.
Both facilities were designed with input from Mid Coast physician leaders to be “patient-centered medical homes,” an emerging health care model that's based on treating patients proactively, instead of passively waiting for them to walk through the door with a health problem. It also involves coordinated teams of physicians, nurse care managers and behavioral health specialists, working together with their patients, talking with them about the positives and negatives of different treatment options and related costs.
A more recent initiative, with far-reaching implications, is the consolidation of the 55-bed Parkview Adventist Medical Center's inpatient and emergency services at Mid Coast Hospital. Under the proposal unveiled in mid-June, which coincided with Parkview's filing for Chapter 11 bankruptcy, a new Mid Coast–Parkview Health System would be created. [The filing triggered a challenge by Central Maine Healthcare Corp., which claimed Parkview owes it and its affiliated hospital Central Maine Medical Center more than $13 million, claims contested by Parkview.]
Skillings says the proposed consolidation will “right-size” acute care services in relation to the population base of the 30 communities served by the two hospitals, while preserving the Parkview campus for physician practices, a walk-in clinic, as well as radiology, laboratory, ambulatory testing and surgery, oncology, hematology, infusion services, physical, occupational and speech therapy services, and community health and wellness programs.
She expects a bankruptcy court ruling in 60 to 90 days. The consolidation plan, if the court concurs, would take at least a year to implement. Skillings says her leadership team and their counterpart, led by Parkview CEO and President Randee Reynolds, are already engaged in that process.
“This is a community-driven solution that will preserve a local health care system for generations to come,” she says. “Randee and I have a shared vision of what that means. I think it comes back to 'collaboration' and 'consensus.' We very much have a team approach here.”
She credits her mother, who died when Skillings was 27, as the role model for her own approach to being a health care leader.
“She was an amazing woman, a consummate people person, she used humor to get along with everyone,” Skillings says. “For about 15 years, she ran our family store in Pownal — a convenience store with a lunch counter. My mom was such a hard worker. She truly saw the best in people.”
Asked what motivates her, Skillings answers within a heartbeat, “I'm driven to improve health care. I don't see that challenge as a problem or a burden, I see it as an opportunity. This time we're now in really fits with how I see things. You can't improve by maintaining the status quo.”