How Regionalization Benefits Patients:
The Sutter Lakeside Story

By Diane Pege, MD, MMM, Vice President of Medical Affairs, Sutter Lakeside Hospital and Medical Director, Sutter Medical Group of the Redwoods - Lakeside Division

For many years, Lake County has suffered from a shortage of urologists. A population our size needs an additional 1.2 urologists to meet community needs. It is difficult to recruit specialists to a small community when only one specialist is needed. In addition, specialists need state-of-the-art technology for some procedures, but it simply is not cost-effective for Lakeside to invest in expensive new equipment when our volume is so low.

What is the potential impact on our patients? Delayed care, difficulty with continuity of care issues, primary care physician frustration, and transportation challenges for our elderly population.

At Sutter Lakeside, we have been working with the Sutter Pacific Medical Foundation on a solution. Starting in 2008, Lakeside created a division of Sutter Medical Group of the Redwoods (SMGR), the medical group in Santa Rosa affiliated with the Foundation.

In addition to adding primary care physicians to our medical community, we are partnering with the Foundation to provide specialty services.

Through a new joint venture between Sutter Lakeside Hospital and Sutter Pacific Medical Foundation, the Santa Rosa-based SMGR urology team now comes to Lakeside two days a week to see patients and perform outpatient urology procedures. If a more complex inpatient procedure is required, the patient is treated at Sutter Medical Center Santa Rosa - by a physician the patient already knows and by a team that covers the specialty service at that hospital 24/7. An added bonus is that patient follow-up can be done locally, so that patients only need to travel for the procedure itself.

2009 Accomplishments

2009 saw tremendous accomplishments and many opportunities at both the affiliate and regional levels in the Dashboard areas of Quality and Safety, Patient Satisfaction, People, Finance, Growth, Community and Organization.

Throughout all of these efforts, West Bay physicians, employees and volunteers have continued to focus on our core mission and commitment to meeting the health care needs of the local communities we serve.

Just in one area - Quality and Safety - we saw major accomplishments for the fourth year in a row. Examples include:

• CPMC was the recipient of the Leapfrog Top Hospital Award
   
• Marin General Hospital and Novato Community Hospital received the California Hospital Assessment and Reporting Task Force Award
   
• Sutter Medical Center of Santa Rosa received the Diamond Trophy from VHA
   
• Sutter Lakeside reached full performance targets for inpatient and ambulatory surgery patient satisfaction

Nonetheless, we must focus even more strongly on all aspects of our Dashboard in 2010, with the intent to achieve Full Performance in every area, particularly in Quality and Safety, Service, and Finance. We are not yet where we need to be, according to Dr. Brotman.

Significant Progress made in formation of the West Bay

As a region, we can streamline decisions, combine our expertise and services, and provide more coordinated and cost-effective care. To meet these goals, our affiliates spent much of 2009 working in partnership to develop regional governance and management structures as well as a West Bay Strategic Plan with detailed tactics.

We began 2009 with five hospital entities, two Physician Foundations and one Health Care Center. Soon thereafter, the West Bay Region began to take shape, beginning with the appointment of Dr. Brotman as Region President.

View examples of what we accomplished by year end.

How Regionalization is Directly Benefiting Patient Care

Ultimately, the goal of regionalization is to enhance the care we provide patients across the West Bay. Here are some examples of key patient care developments that have occurred.

• A new arrangement whereby Sutter Lakeside physicians were provided easy access to CPMC specialists for physician consults (See Diane Pege, MD article for detailed story).
   
• Three Sutter Pacific Medical Foundation neurologists located in both Marin and Sonoma Counties - Richard Mendius, MD, Smriti Wagle, DO, and Max Duncan, DO - were able to close a serious gap in Sutter Santa Rosa Medical Center’s inpatient neurology consultative service.
   
• CPMC’s Stroke Program Telemedicine Outreach, under the direction of David Tong, MD, is now available to all West Bay affiliated hospitals. In a disease where every minute counts, the ability to provide expert stroke care at the local hospital setting can mean the difference between recovery or death.
   
• A West Bay Region Transfer Center has been implemented to facilitate transfer of patients among our affiliates when services are not available in the community.

Sutter Pacific Medical Foundation: "Official" as of January 1

By Morris Flaum, MD, MBA

As of January 1, the Sutter Pacific Medical Foundation is “official.” This new organization combines Sutter Medical Foundation North Bay (which has a strong presence providing primary and secondary services in Sonoma and Lake Counties) and Physicians Foundation of California Pacific Medical Center (which has served San Francisco and Marin Counties). Employees are now part of a single organization, and physicians are part of a coordinated medical network along the Highway 101 Corridor.

The combined expertise and infrastructure into a single organization means that we will be able to offer more effective and efficient medical care, deeper expertise, and access to specialty services. Ultimately, we will offer a continuum of comprehensive primary, secondary, tertiary and quaternary care to patients throughout the West Bay and all of Northern California.

Our 2010 priorities include:

• Operationalizing the combined organization - everyone embracing our mission, vision and values; management operating as one team; and managing the necessary changes without disruption to patient care and operations
   
• Building a robust primary care and specialist network - continuing our expansion of primary care and specialty physician practices along the Highway 101 Corridor from Lake County, through Sonoma and Marin, to San Francisco
   
• Achieving our Dashboard goals - patient, physician and employee satisfaction as well as quality, financial health and growth, and community benefit
  

Report: Physician Needs Assessment/Action Plan

By Toni Brayer, MD, Chief Medical Officer

One of the first tasks we initiated following regionalization was a Physician Needs Assessment. Completed in December, it included input from affiliate Medical Executive Committees and Foundation Medical Groups. In addition, all physicians in the region had the opportunity to provide input through the West Bay Physicians Advisory Committee (WBPAC), an advisory committee to the West Bay Boards of Directors.

Here is what we learned from the Physicians: the overarching need is for effective communication among the West Bay Boards of Directors, Management, and Physicians. In response, we are planning a number of efforts, including the development of a West Bay Physician’s website as well as regular email reports from me to all physicians in the region.

The Needs Assessment also identified the following key priorities:

• Regional Transfer Center (up and running as of 1/4/10)
   
• Regional Referral Program (online physician directory and teleconsults)
   
• Regional Quality Improvement Support, including quality improvement and data analysis
   
• Regional Clinical Education (CME, visiting lecture panel, videoconferencing network, streaming video, webcasting/webinars, Simulation Surgery Training Program)
   
• Resident Training Coordination (retaining residents in Sutter Health practices, including facilitating placement; swapping rotations throughout the region, and developing/sharing electives)

Other identified needs included Physician leadership development and on-boarding of new recruits – both community and Foundation.

Planning and implementation efforts are already underway on many of the above. It is important to me, to the Boards of Directors and to the entire Regional Management Team that we deliver results that physicians can see. Successful implementation will strengthen our patient care delivery system and help physicians in their individual practices.

Please feel free to contact me at brayert@sutterhealth.org if you have any questions or comments.

West Bay 2010 - 2013 Road Map

In 2009, seven Planning Workgroups met to develop key strategic objectives. The outcome was the 2010 - 2012 West Bay Strategic Plan, which was received by the West Bay Boards at their November Joint Board meeting and further addressed at their January meeting.

This comprehensive plan, which will serve as a three-year Road Map for the Region, includes strategies and tactics in the areas of Physician/Growth, Organizational Development, Clinical Programming, and Facilities and Capital Planning

View examples of the tactics that are underway
to support our core strategies.

Organizational Update:
How the West Bay Links to the Sutter Health System

In order for the Sutter Health system as a whole to be successful, the regions must not work in silos. Strong linkages are necessary between the individual regions and the system, as well as among the five regions themselves.

It is through these linkages that we can share best practices, avoid expensive redundancy, reduce “leakage” of patients from our system to obtain services elsewhere, provide services with affordable excellence, reduce costs of materials and supplies, and improve our decision-making processes and the efficiency of our governance and management.

Important working relationships are now in place that directly link West Bay leadership to system leadership.

View the region management organization chart.

View examples of how individual members of the Region Management Team
are involved in systemwide efforts.

Affiliate News

View news updates from West Bay affiliates.

Feedback?

We want your feedback. Email your comments or suggestions to grahamkl@sutterhealth.org.

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