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Patient Family Advisors (PFAs) Role in Mergers and Acquisitions
Mary Lynne Knighten, DNP, RN, NEA-BC and Alice Gunderson, BS/BA
Health Care Consultants and Lead Patient Family Advisors
Guy Phipps, RN, BSN, MBA, CNML
Executive Director of Clinical Services
Derek Drake, DNP, RN, NE-BC, CNML, CNL
Former Chief Nursing Officer (2016-May, 2020)
Mary Lynne Knighten, DNP, RN, NEA-BC Lead Patient Family Advisor
After attending this session, participants will be able to:
1. Describe the merger and acquisition process and the impact on the organization.
2. Identify the role PFAs play during and after a merger and acquisition transition.
3. Describe how a PFAC and hospital can pivot to remain engaged during a pandemic.
Learning Objectives
St. Francis Medical Center Profile • One of the largest Disproportionate Share Hospital in the nation
• Only comprehensive, non-profit health care institution serving Southeast Los Angeles
• The Medical Center operates: • A 384-bed acute care hospital • Busiest private emergency & Level II Trauma Center in LA County • Family Life Center with state-of-the-art Neonatal Intensive Care • Psychiatric Service Line • STEMI and Primary Stroke Receiving Centers • A Health Benefits Resource Center, and • Children’s Counseling Center
• The payer mix for the hospital is about 50% Medi-Cal and 1% self pay/charity care
Historical Perspective
Historical Perspective
Historical Perspective
Historical Perspective For-Profit Consideration
Other variables: • Labor costs were 70% of revenue compared to 40-50% in the industry • Poor managed care contracts—paid less than Medicare &Medi-Cal
Historical Perspective Prime Healthcare Round 1
Historical Perspective—Eight Year Journey
Historical Perspective—Eight Year Journey
August 2018
Verity files bankruptcy Chapter 11 protection
December 2018
Santa Clara County bids on O’Conner & St. Louise
Asset Purchase agreement approved
January 2019
KPC Global bids on four remaining Verity
hospitals
Bidding competition approved by
bankruptcy court
KPC winning bidder
December 2019
KPC chooses not to close the purchase; alleges Verity misrepresentation
January 2020
St. Vincent Hospital Closes; re-opens as LA Surge
Hospital
Bidding process re-opens with Prime Healthcare as winning bid for SFMC &
AHMC Hospitals as winning bid for Seton & Seton Coastside
August 2020
U.S. Bankruptcy Court approves Prime as best and highest bidder
for SFMC
U.S. Bankruptcy Court approves AHMC Hospitals as best and highest
bidder for Seton and Seton Coastside
What Really Happens during a M & A Process
Fear of Making the Wrong Decision
Risk Anticipation vs. Risk Aversion vs. Risk-Taking Actions
System that is no Longer a System (reducing overhead, lack of support)
Inertia and Paralysis (operations, decision-making, business development, contracts)
Lack of Growth
Further Financial Decline (cash-on-hand, threat of/actual bankruptcy)
Repeated Culture Shock (definitive transitional agreements)
Brain Drain (leadership, medical staff, front-line)
Recruitment and Retention
Disruption of Services (contracts, service lines, conditional actions)
Impact on Relationships (community, political, CBAs)
Derek Drake, DNP, RN, NE-BC, CNML, CNL Former Chief Nursing Officer (2016-May, 2020)
Mergers and Acquisitions Across the Nation
Mergers and Acquisitions Across the Nation
With 115 deals in 2017, activity was up 13% from 2016.
The value of M&A activity nearly doubled
given the same volume of activity
Mergers and Acquisitions Across the Nation
In the first quarter of 2019, the quarterly volume of announced acute care hospital merger and acquisition activity reached its lowest point since the fourth quarter of 2009 LeMaster, R. & Henkel, K. (2019). Announced Quarterly Hospital M&A Volume is the Lowest in Nearly 10 Years: Market Perspectives – 2019, Ponder & Co., (1.4), p.1.
Hospital Bankruptcies Across the Nation
Mergers and Acquisitions Amidst COVID-19
Respect for the PFA Role
• Recognizes the importance
of patient and family
involvement in health care
decision-making
• Emphasizes the strengths,
priorities, and preferences
that are unique to each
family
• Encourages a partnership
among patients, families and
health care professionals Hospital Week 2019
PFA Leadership in the Hospital and Community
"If we are to engage them - that is, make an emotional commitment to them - we might start by listening to them more and judging them—and the choices they have made—less.“ ~Alan Weil on Health Affairs Blog, " Five
Engagements that Will Define the Future of Health"
PFA Leadership in the Hospital and Community
Identify
Advise
Participate
Support
Represent
Evaluate
Educate
Health Fair 2019
The Role of PFAs on the Governing Board
Advancing the Strategic Plan
• Growth of PFCC Model beyond SFMC walls
• PFA Council balance membership of PFAs and hospital leadership
• Co-design as a primary construct
• Recruitment of more PFAs
• Collaboration with Volunteer department to support key PFA initiatives
• PFA representation on key medical staff committees
…To reinvent health care in this new consumer-driven world, it’s long past time to begin shifting power back toward the patient. ~ Don Berwick, MD
Alice Gunderson BS/BA Lead Patient Family Advisor
Birth of the PFAC at SFMC
PFCC model was adopted at SFMC • May 2010 – Mary Lynne Knighten hired (Sr. Director) architect of PFCC model; doctoral project was on PFCC.
• June 2010 – Alice Gunderson - first PFA recruited and seated on QPS committee of hospital board
Birth of the PFAC at SFMC
February 2011 – initial PFA Council with 4 Patient Family Advisors
• Developed our Mission and Vision
• We came from the OUTSIDE either as a patient or family member of a patient with positive suggestion to improve patient care and services
• The ability to “take a sow’s ear and make a silk purse”
• Each PFA had a story
• We’re NOT a support group
Growth of the PFAC at SFMC
Developed strong relationships with “C-Suite” Leaders
• Invitation to PFA Council meetings to share their mission and vision….how can we help?
• Rounding with C-Suite leaders
• PFA’s hospital committee involvement: Bio –Ethics, QPS, Re-admission, Nursing Orientation, Research, Grievance, MCH Making a Moment
• PFAC Projects: ICU Compassionate Listener, Patient Guide, Ped’s Playroom, Patient Family Faculty, Nurses week, All Saints Café, Code Sepsis brochure, Advocacy Week, Research Symposium, PFCC Video project, Alzheimer’s/Dementia Support Group, NODA, Honor Walk, etc
February 2014 – August 2020: Period of confusion • “It feels like a divorce”….”It feels like a death in the family”
• PFA Council kept its focus and course
• Did not lose a single PFA
• Partnered with administration and medical staff to assist during transition.
• We now worked from the INSIDE out into the community where FEAR abounded that “their hospital” could be shuttered and closed
• PFAs served as a conduit to share the community’s concerns
• PFAs spoke on behalf of the community at Town Hall meetings held by the California Attorney General’s Office
• PFAs brought the message from the CEO out into the community.
• PFAs became ADVISORS to and for SFMFC and PARTNERS with SFMC.
Actions PFAs Take to Leverage Partnership During M&A
• CEO personally invested in PFAs, came to PFAC regularly to answer questions, dispel rumors, communicate truth, provide support
• Shared concerns as well as hopes
• PFAs received same communication as hospital and system employees AND at the same time
• Painted clear picture of financial and quality data
• Real-time communication (same level as employees and physicians
Need for Transparency
Constant Presence in the Face of Change • Change of CEO (third time)
• Change of CNO – (pending 7th time)
• Name changes
• PFAs served on the Attorney General’s local Governing Board
•
• PFA Council structure changes
• PFAs interviews by Attorney General rep each time
• PFAs Participated in Town Hall meetings
• Virtual PFAC meetings during pandemic
Constant Presence—Into the Future
•Partnerships (Inside): • Expanded the ICU Compassionate Listener Program to train volunteers
• Developed hospital “No one Dies Alone” program and trained volunteers to staff the program • Instituted a 24-7 inter-faith chaplain service • Created “How to be a Partner in Your Health Care” physician/patient booklet • Participated in “Make a Moment” in MCH • Filmed and produced PFCC video
• Partnerships (Outside): • SCPAB (Spanish Community Policing Advisory Board)
• “Aging Well Health Fair” (SFMC, Keck USC, Mexican Consulate) • Hospice Video Research project with CSU Northridge • Farmer’s Market (future)
Lessons Learned • Importance of the “C-Suite” connection
• Stories: PFA do not always have specific data to base
• Improvements and service suggestions upon but stories that are relatable go a long way
• Importance of true Partnerships
• PFAs ARE THE COMMUNITY…..EVEN THO’ OWNERSHIP’S CHANGE, LEADERSHIP CHANGES, STAFF CHANGES….
PFAs ARE ALWAYS HERE TO STAY IN THE COMMUNITY!!!
Guy Phipps, RN, BSN, MBA, CNML Executive Director of Clinical Services
Lessons Learned
• Leadership and PFA partnership has transparent, positive results and the relationship endures, despite leadership changes
• PFAs provide constancy and stability during times of chaotic change (no attrition)
• Patients and families are personally invested in their hospital/health system from grassroots movement to board representation
• PFCC model of care maintained through transitions
• PFAs supported frontline staff with rounds (pre-COVID) & messages of encouragement
• Provided insight during pandemic to improve patient care (e.g. Purposeful Rounds)
Partnering with Patients and Families During COVID
• Purchased iPads for physician rounds, patient-family conferences, conversations
about serious illness and care decisions (treatment, palliative care, EOL), fear of
HAI, and… simply communication between patient and family
• Nursing leaders meet family in the lobby: updates, discuss precautions
• COVID Purposeful Rounds • Time of rounds on the patient’s White Board • Educate patient and family about:
• simple description of the disease process • purpose of medications and how they work • expected testing and treatments • symptoms they may be experiencing • report to the nurse: any increased respiratory effort/ shortness of breath, chest discomfort/tightness, feeling confused, having trouble staying awake, any new symptoms
• Plan for direct care nurse, SW, CM, and/or Chaplain will call the family once a day to provide updates
• Family presence in OB, EOL situations (non-COVID patients) • Communication to the community from Chief of Staff, ED and MCH Medical Directors that procedures, processes, care is safe • PFAs provided virtual real-time input to policies and procedures
Into the Future with Prime Healthcare: PFA & Hospital Partnership after M&A
• PFAs participating in the interviews of leadership and other key positions
• Sharing the patient story at orientation and huddles to build empathy and
understanding about the patient experience
• Develop more patient and family-centered policies & procedures
• Access to corporate resources to support PFCC
• Active support from Prime Chief Patient Experience Officer and team
• Share best practices with other Prime PFACs across the nation
• Potential for PFA input for patient portal in new EHR (hoping for…Open Notes)
• Resources for PFA recruitment/support
• PFAs will contribution to re-opening plans and processes
St. Francis Medical Center…
THE HEARTBEAT OF THE COMMUNITY
