M E M O R A N D U M

 

TO:	Chris Cochran, Ph.D., Practicum Instructor, Health Care Administration Program, University of Nevada Las Vegas
FROM:	Ather Ahmed
DATE:	November 29, 2004
SUBJECT:	Practicum Site Visit (where and when)

 

In this memo, I will speak about the various hospitals visited. This will include an overview of daily operations, types of organization, future plans, SWOT analysis, and unique information about the particular campuses. The campuses visited included; Boulder City Hospital, St. Rose Dominican (Siena Campus), University Medical Center, and Sunrise Hospital.

Boulder City Hospital

The first hospital that we visited as a class was the Boulder City Hospital. Our visit took place October 8^th, 2004. This is the only hospital near Hover Dam, and is located 20 miles away from Las Vegas. The host of our tour at Boulder City Hospital was Mr. Kim Crandall, who is also the CEO. In our tour, Mr. Crandall mentioned that the Boulder City Hospital is working on developing a critical access hospital status in the near future. The benefits of becoming a critical access hospital will be to save time for residence of Boulder City and provide services for rural populations including scattered populations in northern Arizona.

            The Boulder City Hospital is a private, not for profit organization. The hospital has a joint venture in assistant living. The hospital is also a member of the Nevada rural Hospital Association. The institution itself was built in the 1970s. The hospital currently has 300 employees, with 150 full times employees. Approximately 50%  are Medicare/Medicaid recipient patients. In addition, 400 patients a month come to ER for acute care services. The rooms are divided into the following: 22 acute care, 47 long term, and 4 ICU beds. There are no major surgeries or procedures done at the hospital, all major services are taken straight to Las Vegas via Ambulance or Helicopter.

St. Rose Dominican, Siena Campus

The second hospital toured was St. Rose Dominican, Siena Campus. This was by far a phenomenal hospital. Our visit to St. Rose Dominican, Siena campus took place on October 22, 2004. St. Rose Dominican hospitals are all non profit, private organization owned by (CHW) Catholic Healthcare West. St. Rose is a religious based hospital with , a strict devotion to the best patient care possible. Our host was Mr. Matt Koschman, who is the VP of Business Planning. We started off with a tour of the facility, which included a brief visit to the patient care rooms, ER, children’s section, and the healing garden. The institution currently has 214 acute care beds, with expansion plans to add an additional 140 more beds. The patient to nurse ratio is incredibly the lowest ratio of 2-1 defines care to a different dimension. In addition, there are 26 ER beds and plans for a level three trauma in the future.

            One of the most unique features of this campus compared to the many visited was the healing garden. This garden is devoted to give the patient a piece of mind during the healing process. After the tour of the healing garden, we then were led to the Administration Offices, where Mr. Koschman introduced the class with Rod Davis, CEO of the Siena campus; Parmad Gorg who is the CFO; Sandra Cronwell, Chief Nursing Executive; Anna Montanna, HR director; and Vicky van Motreen who will be the future CEO of the San Martin campus due to open in 2006.

            During our visit in the Administration’s meeting room, various nursing issues were raised in regards to recruitment, including information about the latest 100 newly recruited nurses from India who all hold master degree level training. Plans for the new San Martin campus were also being discussed including the cost of the project, which is approximately $140 million dollars, which $110 million will be financed by bonds, through Citibank. The plan is to raise an additional 20-40 million dollars through donations to create the new San Martin campus. In addition, the only non profit, private hospital in southern Nevada is St. Rose Dominican hospitals. 

University Medical Center

The third hospital facility that our class visited was University Medical Center.  Our visit took place on November 5^th, 2004, where we were greeted by Mrs. Prabha Cox, who is the manager of worker’s compensation and benefits. In addition, we were introduced to John Espinoza, director of HR; Chris Roth, assistant administrator; D. Blaine Claypool, COO; Vicky Huber, Nursing Manager. Lacy Thomas, not present at the meeting is the CEO of the organization. Mr. Roth and Mrs. Cox lead the class through the UMC tour providing interesting facts and statistics.

UMC is a non profit, government hospital, owned by Clark County. At the moment, UMC holds the lowest nurse turnover rate in Nevada. Patient care ratio is about 5 patients to 1 nurse. UMC is the only hospital in NV to rank among the 50 best Trauma hospitals in the United States.

 Bad debts are approximately $160 million in 2003. This included 18% from the whole UMC network of Quick and Urgent Care centers. About 75% of quick and urgent care patients have insured patients. UMC is about 75 years old, with 575 acute care beds, running at 100% occupancy at all times. There has been an addition of 90 new private patients’ rooms. It was estimated during the visit that the OB/GYN was at 110% capacity. UMC currently employees approximately 3700, this includes ancillary, nursing, technical and professional staff members. Some of the specialties UMC is known for are their level one trauma center, transplant center, and pediatric hospital.

 The UMC network is dependent heavily on government grants insurance and payments from patients. Unlike St. Rose, UMC receives no charities from private donors. The county grants UMC $15 million dollars each year, and balances a half billion dollar budget yearly. A $59 million dollar expansion is on the works, which will provide additional patient care rooms, newer technology, and the capacity to take care of more patients. UMC is also known as the top 10 busiest trauma centers in USA, covering the tri state.

Sunrise Hospital

The final hospital that was visited was Sunrise Hospital, which took place on November 19^th, 2004. We were greeted by the CEO of Sunrise and HCA of Nevada, Mr. Brian Robinson. Sunrise is a private, for-profit organization, owned by HCA. HCA is also known as the single largest health organization in the world. Mr. Robinson pointed out that Sunrise is in its 9^th straight year winner of consumer choice awards. Mrs. Judy Royer provided with the class with the campus tour. Mrs. Royer is also part of the volunteering department at Sunrise.

Sunrise is proud to be the best in pediatric care with its state of the art children’s hospital. One of the most unique processes at Sunrise is the introduction of the heart freezing program, this procedure is mainly used on infants to repair cardiac related problems. Sunrise is also specialized in pediatric heart care. Sunrise is one of five centers to hold the heart freezing technology in the nation. Sunrise has stated to have the largest providers of oncology related care in the world, along with the best cardio section around, this is due to the CICU unit which opened early this year. Currently there are 117 beds in ICU, 42 in CICU which is the cardiac ICU. The campus holds 701 beds, which is the largest in the state. The trauma unit will be opening its doors in January. Dr. Michael Mesler will be the head of the trauma unit. At the moment, there are 24 OR beds, 14 beds will open in the new trauma ICU. 

Currently, Sunrise accumulates between $7-10 million in bad debts. Mr. Robinson openly admits that the trauma center isn’t a good money maker, yet provided as a need to the community. At the moment, there are 600 beds for acute care services available, with 575 beds taken on a daily basis. A new 200 bed children’s hospital will be opening in the future.  The patient to nurse ratio is 8 patients to one nurse in the acute care units, 6 patients to one nurse in the surgical units, and 2 patients to one nurse in the ICU unit. Annually, Sunrise creates $ 2 billion in revenues, with 3000 employees serving proudly. Additional information include 120 surgeries are done per day, 5900 babies are born annually, and one of the first and most sophisticated NICU which can accommodate 50 babies.

Possible projects

            The Boulder City Hospital is willing to take an intern who will be involved in either accreditations or planning the critical access hospital within the Boulder City Hospital which will be added in the future.

            St. Rose Hospital is currently seeking an intern who is interested in the business development of the new San Martin campus. This position will allow the intern to learn how to start up a new hospital, which will open in 2006.

            UMC currently has four spots available for potential projects, the exact projects were not mentioned in detail, however provided application and questionnaire to determine which department the student is interested in working with.

            Sunrise didn’t mention any potential projects for UNLV students. However under scrolled Masters students from IB league universities taking outstanding position within administration through HCA’s COO program available for only master degree candidates. 

            I am interested in working on the San Martin project at St. Rose Dominican. The reason why I feel this way is because the employees involved seem to be easy to work with individuals. In addition, the business development aspect of an organization is more relevant to my coursework. I feel that this project will give me the challenge I am demanding, which will serve not only as educational, yet involvement in history of an organization that is yet to open its doors to the public.

            One similarity found at each hospital is the crowded emergency room, except for Boulder City due to the size and location from Las Vegas. In addition, many administrators pushed the emphasis on trauma unit within their organization, shortness in nursing staff, and losses due to bad debt.

            The main differences between the campuses overall would be the profit vs. non profit organizations. The main differences were visible with the patient to nurse ratio, the aura, and the prides within the employees were enough to understand which organization took more pride in servicing. The non profit organizations are more focused about patient care and wellness then for profit organization. Working for Sunrise half a year ago, I felt that patient care was the least of the worries compared to saving cost by reducing labor, and reducing patient to nurse ratio regardless of the shortage. However, I didn’t see any of this at any of the non profit organizations. Which is why Sunrise made a $2 billion dollar profit last year, with a handsome amount awarded to the last CEO before. 

 

 

 

 

Name of hospital	UMC	Sunrise Medical Center	St. Rose Dominican Hospitals	Boulder City Hospital
Name of CEO	Lacy Thomas	Brian Robinson	Rod Davis	Kim Crandall
Type of Facility (e.g., For-profit, non-profit)	Public, Non-profit	For profit	Private, Non-Profit	Private, Non-profit
Number of beds	575	701	214	76
Number of employees	3700	3000	1500	300
Service area 1.        Primary 2.        Secondary 3.        Tertiary	Trauma Unit, pediatrics, Obgyn, Burn Center	Cardiac care, inpatient surgery, pediatrics	pediatrics, cardiology, acute care	mental health, long-term care, and minor acute care
Specialty areas	Level 1 Trauma, Transplant Surgeries, Children hospital, burn center, OBGYN,	Neonatal, Heart Freeze Technology, children hospital, cardiac intensive care unit, level 2 trauma, oncology, obgyn, unit	Acute Care	Acute and Long Term Care
Strengths	Government funding	Member of HCA	Member of CHW	Member of Nevada Rural Hospital
Weaknesses	Bad debts	Patient to nurse ratio endangers care of patients.	Due to Catholic affiliation, many might feel discriminated.	Small population dependent upon Medicare/Medicaid
Opportunities	Massive $59 million expansion	Level 2 trauma, expansion of children beds.	Expansion and San Martin campus will provide and reach more patients.	Plans for critical access care
Threats	Funding	Level 2 might not make money	None	Funding

 

 

The tables have been created to highlight a SWOT analysis side by side of the four campuses visited. These are my observations, and feel that they can be challenged. However, this is the information I accumulated and should be as accurate as possible.

In conclusion to the memo, I would like to express my appreciation for the tours provided. I feel that with such knowledge that has been gained, has given me a better understand how private, public, profit and non-profit organization operate. I feel that non profit organizations are geared more towards patient care then for profit organizations. The hospital which stands out the most in this visit was definitely St. Rose Dominican due to their sophisticated technology, patient to nurse ration, and the aura within the building which demonstrates patient care as a priority over financial matters.