Healthy Steps: A hospital administrator’s struggle to save Doctors Medical Center

Dawn Gideon remembers walking down the steep stadium steps of the Ashland Regional Medical Center auditorium, staring at the backs of the heads of 100 hospital workers, each step taking her closer to the front of a crowd filled with people she had known for only a month.

It would be her first attempt at saving a hospital.

“Oh my God, I have to save these people’s jobs, and I haven’t even looked in their eyes yet,” Gideon remembers thinking. She approached the auditorium floor. Row upon row of physicians and hospital staff, gathered for her briefing on the fate of their small hospital in eastern Pennsylvania, looked up at her.

Gideon got to the point.

“We have no money,” she said. “We’re in panic mode here, folks.”

The community had few other options for health care. The hospital had no money, not even enough for payroll.

Six months later she sold it to a for-profit company to keep it afloat. The hospital would stay open.

That was 12 years ago. Since then Gideon has specialized as a kind of jet-setting hospital-saver consultant with Huron Consulting Group, based in New York.  She’s worked at nine organizations, responsible for 23 different hospitals, each time with the same mission: calm employee anxiety, make tough decisions, keep struggling hospitals afloat and keep medical care available to the community.

This year brought her a new salvage target in Contra Costa: Doctors Medical Center in San Pablo, where she has served as interim CEO since March.

***

Gideon walks out of her second-story office, through the halls of the hospital, as she tells me town hall meetings are her thing. Since she’s been at Doctors, she’s made it a priority to speak in-person with each department – it’s part of her weekly schedule, recorded like all of her meetings in the iPhone calendar she checks constantly. She also has a Blackberry, where she keeps all of her schedules and accounts for Huron.

We reach the elevator alcove, and she stops, turning her head to ask me: “Do you mind the stairs?”

We walk down the steps, the smell of day-old, white paint seems locked in the narrow stairwell. I wonder if she’s the only person who always takes the stairs.

“I don’t pay for a gym membership to take the elevator,” she says.

The stairs are the unclogged arteries Gideon travels up and down to pump new life into the frail hospital.

She takes them department to department, briefing her staff on the latest decisions her administration and the board have made or plan to make.

For the past nine months, she’s been trying to save Doctors. Many would argue she already has. The proposed budget is balanced, and the hospital has survived the past year largely due to partnerships she forged with Kaiser Permanente and John Muir Health. She also helped pass Measure J, an annual $47-per-household parcel tax for west Contra Costa County residents that promises more than $5 million in funding to help close the struggling hospital’s $18 million budget gap.

Five days before the parcel tax vote, a Thursday, we stop at the cafeteria.

Contra Costa County Supervisor John Gioia addresses a crowd gathered for the J.C. Robinson Regional Cancer Center open house at Doctors Medical Center on the evening of the Measure J election. Gideon (center) looks on and listens in the background. (Photo by Hasan Dudar)

Gideon seems slightly nervous about the vote, but the handful of employees standing on the cafeteria’s pale-green kitchen floor are confident the measure will pass. She tells them the campaign is planning to go canvassing over the weekend as one last push to garner support. But the confident looks disappear when she tells them the next step is finding permanent leadership for the place – someone other than her, she means. Her job is transient by nature: a year in one place, and then on to the next crisis just as she’s formed a real relationship with the hospital employees.

From the cafeteria it’s on to the emergency department. Her pace is brisk but not rushed, not so different from anyone else. It’s a hospital — everyone seems to walk with a kind of urgency, whether they’re trying to save the hospital or trying to save a patient.

In the emergency department there are more pressing worries. The 24-station department is the biggest in the West County. Even with the balanced budget and parcel tax, the hospital’s not entirely in the clear, and Gideon and the medical staff fear the public health impact the ED’s closure would have on the community.

After soft chatter with the staff, paced by the dull drone of the nursing station orchestra of beeping EKG monitors, clicking keyboards, and pens scratching plastic clipboards, one physician pulls Gideon aside.

“Let me show you something,” Dr. Ian Ahwah says, as he directs Gideon toward the only bathroom in the emergency room. “There’s a line, usually out here, of people waiting for the restroom.”

Gideon nods, as the two of them stand huddled in front of the bathroom’s narrow entrance. Ahwah says not even a wheelchair can fit in the crammed doorway.

He then walks to other side of the emergency ward and shows her the employee bathroom and an adjacent closet, fitted with pipes, that could be converted into a bathroom. Gideon agrees this is one of the little details that could improve the hospital for patients. She’s charged with fixing the hospital’s high-level financial situation, but even the smallest things matter.

On her way out of the ED, a maintenance employee stops her to tell her the ward needs more partition curtains.

She stands, leaning to one side, listening.

“I’m sorry to burn your ear,” he says.

“No, you can always stop me and burn my ear,” she says, shaking her head lightly and smiling as she walks away.

Exiting the brightly lit ED corridor through the beige automatic doors, she stops and turns.

“Steps, again?”

***

An iron replica of the Eiffel tower and an abstract watercolor painting Gideon describes as “really nice refrigerator artwork” adorn her office walls, reminders that she can’t get too comfortable and lose sight of what she calls the “burning platform.”

She’s there to turn around, not furnish the place. It’s her job. It’s also her passion. And behind the business attire and business language, there’s a sort of concerned motherly presence about her that shows up whether she’s talking medicine with doctors or taking down notes on extra curtains.

She also takes care of herself. The high-stress situations and tight deadlines don’t appear to have caught up with her yet: there’s no gray in her strawberry blonde hair.

She enjoys her work. She says she doesn’t understand when people tell her they use hobbies to decompress after work. To her, there’s no need to de-stress if you love what you do.

Gideon started working in hospital administration at Forbes Metropolitan Hospital in Pittsburgh in 1983, as a 24-year-old just out of graduate school for public health administration. In 1990, she became CEO of Forbes, and merged the hospital in 1997 with Alleghany University Hospitals, which she guided through bankruptcy a year later. She converted Forbes into a long-term acute care facility and sold it in 1999 to LifeCare Hospitals, a nationwide acute-care system.

Shortly after the Forbes sale, Gideon formed Transition Management Group, which she later merged into Huron Consulting in 2004.

She said she’s seen a lot of struggling community hospitals in those 12 years, but few posed the public health risk Doctors would pose if it were to close. The closest county hospital is Contra Costa County Regional Medical Center in Martinez, over 15 miles away from Doctors. Access to care, Gideon and many county officials said, would be severely diminished if Doctors closes.

“It’s somewhat unusual for an urban community to have limited access to hospitals, emergency rooms, and hospital beds,” she said.

Emergency care in the West County, which accounts for about 250,000 people, would also suffer. The closest emergency department, at the Kaiser Richmond Medical Center, has 15 beds – not enough to handle the influx of patients who would normally go to Doctors, which sees more than 40,000 ED patients per year. The county, which administers the hospital under a special health care district, hired Gideon not just to save a hospital, but to prevent a crisis.

“A lot of times people want to save their hospital for more access to health care and more access to jobs,” she said. “We’re obviously saying jobs are important. That hasn’t been the focus here. The focus here has been access to health care.”

When she’s not at Doctors meeting with staff to find ways to save the hospital, she’s usually in Sacramento, asking the state for funding to resuscitate it. But her efforts at the statehouse have been unsuccessful.

“When I’m in Albany begging for money in New York, or I’m in Boston begging for money in Massachusetts to save a hospital, I’m one of four,” she said. “When I’m in Sacramento begging for money, I’m one of 40 or 50 hospitals.”

Figuring out ways to raise revenue and cut costs for the hospital led Gideon to many sleepless nights.

In August, she laid off 11 employees and eliminated 33 positions. She said she’s tried not to become desensitized to layoffs.

“My personal philosophy is that, if you’re going to have a layoff, you do it, you do it once, and you move on,” she said. “And you need to give the people that are left some degree of comfort that you’re not going to have another layoff next month and the month after that.”

But Gideon said she has to remind herself that the ultimate goal is saving the hospital. And while Measure J promised one part of that – additional revenue – there’s also cost-cutting and partnerships that Gideon has had to form to keep the place going. This is actually her second project at Doctors; she served as the hospital’s bankruptcy restructuring officer in 2008 and helped secure $16 million in funding from Kaiser Permanente and $3 million from John Muir for a three-year period. Now that Measure J has passed, her work will revolve around improving the hospital’s reputation for patient care and satisfaction, which she sees as central to reviving the hospital’s flagging finances.

She’s in a high-stress position, but Gideon does sometimes sleep – the only thing is, she wakes up at 4:30 a.m. Her morning routine consists of exercising on the treadmill and talking to her colleagues at Huron who, at 6 a.m. Pacific, have already started their day. Then, at 7 a.m., she starts her West Coast workday.

What keeps her going? Worried looks, she says — the ones she first saw 12 years ago at Ashland.

“Walking around a room full of employees who are looking at you and saying, ‘Save my hospital,’” she said. “That’s a pretty big motivator.”

But she also says she can’t do it forever.

After her Thursday rounds at the cafeteria and ED, and an hour-long administrative meeting, she pulled her black, cushioned office chair close to her desk and began sending out emails on her desktop computer. A few minutes had gone by, and she rolled over on the swivel chair, turning to say she recently had dinner with a 62-year-old Washington lobbyist for the hospital who was still on the professional grind.

“The morning after our dinner, I was on the treadmill, asking myself, ‘Can I imagine living this kind of a life in the next 10 years?’ I love what I do, but I wonder how long I can do it without burning out…Can I really keep up with this pace for another 10 years?”

Later that evening she caught a flight back home to Pittsburgh, like she does every week, to spend the weekend with her husband. It’s a five-hour direct flight, which means five hours of emails and readings, five miles up in the air.

***

It’s the evening of the Measure J election. Like a parent who sees their kid’s college admissions letter come in the mail, Gideon plays down her nervousness.

After mingling with guests at the hospital’s cancer center open house in the evening, she heads to the campaign’s headquarters in Point Richmond, where a dozen people are gathered in a political consulting firm’s conference room to hear the results that will be phoned in to County Supervisor John Gioia shortly after eight in the evening.

Gideon arrives solo, walking up the steps at five to eight, her pace sluggish. She’s been up since 2 a.m., and she’s ready to get the vote over with.

At 8:01, Gioia receives a call on his cell phone, grabs a red dry erase marker, and writes “23,923 Yes” on one side of the board and “8,546 No” on the other. As the dozen community members and hospital staff in attendance watch, Gioia circles the number “73.68” on the board, indicating the measure has earned the two-thirds majority it needed to pass.

The group lets out their collective “woohoos” and high-five each other. Gideon smiles and looks relieved. She back steps out of the conference room, and pulls out her cell phone. The first call is all business: her secretary, Lani.

Then she pulls out her black laptop case, and she and her community outreach director Gisela Hernandez slip out of the room to send a hospital-wide email, informing the staff of the news. She returns to the crowded conference room, struggling a bit to maintain a businesslike composure. The parcel tax represents a victory, but there’s still so much to do.

Gideon calls her secretary, Lani, after the Measure J election results were announced. She made rounds at the hospital later that night to celebrate with different departments. (Photo by Hasan Dudar)

After 20 minutes of mingling, she decides it’s time to go back to Doctors to share her joy with the ED and other departments.

During the 20-minute drive to Doctors, Gideon says she still can’t believe the measure passed. She says she understands, too, the meaning behind the vote.

“The irony is not lost on me, that we provide care for a lot of people that are poor…and they can’t afford to pay for a parcel tax increase,” she says.

She parks her Toyota Corolla – a rental, further evidence of her temporary place here – enters through the automatic glass doors, and rushes past the ED security guard, forgetting to show her badge. The guard stops her. She apologizes and continues, straight to Dr. Seth Thomas, the emergency medicine director. He’s heard of the news by now, but she wants thank him for his hard work in person.

“You did a great job,” she says. “You raised the money.”

“It was a team,” he says. “A team.”

***

On a post-election Wednesday, it’s back to business. Gideon plans to attend two afternoon board meetings and a financing corporation meeting that will allow the hospital to issue certificates of participation, which let investors buy into lease revenues, allowing the hospital district to finance more debt.

The new stream of tax revenue, which will help shore up investor confidence, won’t kick in until a year later, so Gideon knows it’s not a cure-all. But going forward, the forecasted revenues should help balance the budget – the budget her staff has to present today to the West Contra Costa Healthcare District governing board.

Before the board hears the proposed budget, they listen to an appeal from a staff member to add on an extra agenda item.

There’s a motion to concede the item, and Supervisor Gioia turns to the rest of the board: “Anyone else want to say something?”

“In addition to yippee?” Gideon says, snapping her head to one side as the rest of the room laughs.

Her chief financial officer Jim Boatman takes the podium to outline the 2012 budget to the board.

Sitting at the short end of an L-shaped table, Gideon listens as she looks through the thick stack of budget meeting papers in her three-ring binder. She follows along, punching numbers into her iPhone calculator, clutching her pen, ready to jot down notes.

After a round of questions from the board, the budget passes.

“Now on to our CEO report,” Gioia says, turning to Gideon.

“Everyone has to take a few seconds,” Gideon says, leaning forward for emphasis. “Just take a breath.”

She looks around the room for a few seconds.

“The challenge is putting together the long-term plan,” she says.

She pauses, then continues coolly, in a business tone, “I intend to be back in December, two days after the Pittsburgh Steelers beat the 49ers.”

They laugh again. When she returns, one thing she expects to accomplish is finding more funding and more partnerships for the hospital, something she sees as “instrumental” going forward.

“We need to think differently about who we are and who we partner with,” she says.

***

The next day, slightly before noon, Gideon walked in from the hospital’s back entrance, headed toward the silver elevators in the lobby. She had just returned from a meeting at John Muir, where she discussed the passing of Measure J and what it meant to the community. She stopped to greet me, and we headed up the stairs – they still smelled of paint, and I wondered if she’d grown used to it.

She dropped off her belongings in her office, and walked back down the stairs, headed to the cafeteria, which was tucked away in the hospital’s basement.

She cased the busy cafeteria, and then walked over to a table where two employees, Carlos and Cathy, were sitting, finishing up their lunches. After introductions, she left to go serve cake to the employees and cafeteria patrons. People walked up to the serving station, and Gideon would hand them a piece of cake, lean over the table, and say something to make them smile.

Cathy and Carlos began talking about the parcel tax and how much it meant to the hospital. They were happy to change the topic of conversation to Gideon.

“I’ve got news for you: she’s the one behind all of this,” Cathy said, in her heavy southern accent, as she poked her yellow soup around with a plastic spoon. “She’s very pleasant. You can talk to her. You know how some executives are unapproachable? She’s approachable. She’s the saving grace.”

In the middle of our conversation, Gideon tiptoed over, set a piece of cake in front of me on the table and silently walked away.

Cathy and Carlos carried on the conversation together. I waited for a break in their speech, then asked how they felt about Gideon leaving soon after the hospital is back in order.

“Oh man, I don’t even want to think about that,” Cathy said. “I think we should kidnap her.”

“We were at ease, knowing the situation,” Carlos said, holding a French fry.

“She wouldn’t just tell you and walk off,” Cathy jumped in. “She would answer questions. I think the bluntness and her openness with how things were – I think it got people serious on how to save money.”

“She knew her staff,” Carlos said. “She was very comfortable.”

The conversation shifted to how much they love Doctors.

“You feel like family here, and you know your patients,” Cathy said. She then looked at Carlos: “Maybe Dawn should move to California. We need to remind her it’s cold back East.”

When Cathy and Carlos returned to work, I went back to sit at one of the square Formica tables near the cake and punch station, where Gideon stood serving cake to employees and patients. She came over and sat across from me. I thanked her for the cake and for constantly offering me snacks during my visits. (Hospitals always seem to be flush with food.)

“Oh no, don’t worry,” she said. “We’ve been so excited lately. It’s been nice sharing it with someone.”

After lunch, Gideon had another busy schedule of meetings. That day she met with the certificate of participation underwriters, her financial advisors, and the heads of all the departments. When it was all over at about six in the evening, she headed down to an empty conference room that sat in a quiet hallway near the gift shop. There was more cake and punch.

A few employees walked by and stopped for a slice of the vanilla and chocolate layered cake. She worried the room wasn’t visible enough.

“We should do deliveries,” she said. “What do you think?”

I agreed.

“We need trays,” she said.

I offered to go look for some in the cafeteria.

“OK, if it’s still open, make sure you bring two,” she said, as she walked the opposite direction to check for trays in the radiology department.

We both returned with trays, and began slicing up the cake – eight plates to a tray.

As she walked out of the office, past the gift shop, she turned toward the stairs, yellow tray in hand. She stopped herself mid-step.

“Actually,” she said, “we should probably take the elevators.”