Best Orthopedic Hospital in U.S.?
How does a 15 bed physician-owned surgical hospital in fly-over country beat out every other hospital in the United States—3, 414 of them—to be ranked number one in patient satisfaction? It would be tempting to ascribe the extraordinary 2009 ranking of the Oakleaf Surgical Hospital to the fact that some of the doctors there barter for payment with their Amish patients—exchanging rocking chairs for the setting of broken bones. But the answer is more complicated.
The Oakleaf Surgical Hospital of Eau Claire, Wisconsin, population 61, 700, had its beginning in the 1990s when a group of independent surgeons reacted to the arrival at Eau Claire’s Sacred Heart Hospital of the Marshfield Clinic, a huge multi-specialty clinic with 52 locations in Wisconsin. Believing that they “had to do something to get some strength in numbers” the doctors made the bold and perhaps brave decision to compete with both Sacred Heart and Eau Claire’s Luther Midelfort, which was a part of the Mayo Health System.
One of the founding orthopedists in a group of about 50, Dr. John Drawbert, remembers, “We knew we were going to alienate the big hospitals where all of us had worked but we also knew that our future with them was not on great ground. The biggest difficulty initially, ” he said, ” was having the guts and gumption to do it. We had to convince the folks who for years had depended on the big hospitals that this was the right way to go.”
Why a physician-owned hospital? Drawbert, who is also board chairman, says, “If I were a physician contemplating this I would ask, ‘What is the advantage?’ The answer is that you can control the quality of care, you can control the quality of staff. You can control your environment—the way things flow. Any one of us who has worked in a big hospital knows that there you are thrown in with some staff members who care and with some who do not. Things can run incredibly slowly. The environment may not be great but you have no chance to improve it. Here [in your own hospital] you can completely change the environment to your liking. That to me is the best thing that a place like this has to offer.”
Drawbert now does the same number of surgeries in one day that took him two or two and a half days to do in other hospitals. When he learned of the hospitals’ Picker score ranking of 98%, he was not surprised. His response was to wonder what the staff could do to move it to 100%.
The Oakleaf Surgical Hospital, which opened in 2001, is located next to a shopping mall. The staff performs just under 8, 000 surgeries a year, about 40% of which are orthopedic procedures. The hospital is licensed for 13 inpatient beds and 15 outpatient—defined as 23-hour beds. Approximately 80% of the patients are outpatient. There are seven operating suites, six of which run all day every day with the seventh reserved as back up in cause of an emergency or overflow.
Drawbert credits the hospitals’ philosophy of putting the patient first with its success. “We tell nurses and surgeons who come here from other hospitals that if you work here as you would in a normal hospital, it won’t work. The goal here is to treat patients with the utmost respect.” He also requires efficiency.
He tells new hires,
Be very efficient, move things along quickly. We tell an employee that when you are doing a procedure that you should be thinking about step two and anticipating step three. You should be visually thinking about step four. If you cannot do that, you will not do well here.
The costs for surgery at Oakleaf are lower than at the other two hospitals in Ea Claire. As Drawbert explains it, “We feel that to be competitive, we need to be financially competitive. When we built this place it was to establish a quality of life for our patients and staff, not to make large distributions to the docs. We try to keep our costs less than the others.”
Bob Lindberg, chief nursing officer, expands on the many ways Oakleaf caters to its patients. Impressions, he said, begin in the lobby, which, with its overstuffed chairs and couches, its rugs defining conversation groups, its desk with a computer for client use and the prevalence of dark wood cabinetry give the lobby the look of a boutique hotel instead of a hospital.
When patients are checked in each is given a plush teddy bear along with a bag of toilet articles designed to make their stay more pleasant. When patients return from surgery, they are met in their rooms by their nurse bearing a vase of fresh flowers—delivered daily to the hospital by a local florist. A professional chef is in charge of the kitchen and patients order their meals, which are prepared to order, from menus.
Patient’s rooms look more like hotel rooms than they do rooms in a hospital. Medical equipment and the ever-present TV are hidden in the same dark wood cabinets that are featured in the lobby.
Before patients are discharged from the hospital they are escorted from the recovery area to a café called the “bistro, ” which resembles a Paris side-walk café. As Lindberg explained, “They sit down and have a meal with their family before we release them to go home.” The menu lists burgers, patty melts, turkey and ham sandwiches, chef salads . Patients and one family member eat free. Lindberg explained that “the nursing staff wants to make certain that patients are eating before leaving the hospital.”
Lindberg credits the remarkable patient approval rating with the way the staff is treated at Oakleaf. “We make sure the staff needs are met which in turn allows them to take better care of their patients.” While the pay scale at Oakleaf is the same as that in the other hospitals in Eau Claire, Lindberg credits the hospital’s success with the fact that “starting at 6 a.m. every morning we feed the staff and feed them well.”
In a small dining room equipped with steam tables and four round dining tables the chef has Canadian bacon and sausage, cereals, a hot entre, rolls, juices and coffee available for all of the staff until 10:30 a.m. Everyone, the surgeons, housekeeping staff, nurses, eat here together. As Lindberg says, “We do not differentiate, our staff is our staff. All are sitting at the same table eating together.” The breakfast is removed at 10:30 to make room for the lunch which consists of a salad bar and hot entries. This remains in place until 2 p.m. when the afternoon snack is brought in. On the day this reporter visited, the snack was freshly baked chocolate-chip cookies. From 6 a.m. until three in the afternoon there is fresh food, constantly being replenished and brought in to the dining room for all of the staff. Drawbert notes, “We all eat together, same place and same food. There is no doctors’ or nurses’ lounge. That is what makes this flow so well—a team approach.”
In 2007 the doctors sold 60% of the hospital to National Surgical Hospitals, in Chicago, which engages in the management of surgery centers concentrating in orthopedic surgery in partnership with physicians. “We knew there were going to be some Stark rule changes (the federal Physician Self-Referral Law) and we felt this was our best protection against Stark rules and our relationship with them, ” said Drawbert.
Oakleaf is growing. It just opened a wound care and hyperbaric chamber with two dive chambers. It will soon begin construction on a replacement facility. By law it cannot have any more operating rooms or inpatient beds but , as Drawbert noted, “we can put in an unlimited number of 23-hour beds.” When the replacement is completed the wound and hyperbaric center will move into the present facility along with administrative offices and a planned pain center.
Drawbert believes the legislation against physician-owned hospitals is “short-sighted and very slanted. Many studies of physician-owned hospitals show that the infection rate is about half that of a community hospital and the customer satisfaction scores are frequently double. It is not about cost and quality. It is purely a lobbying effort by the hospital association. I feel strongly that it is a bad piece of legislation.”
And then there are the Amish who, in the main, do not buy health insurance. “The Amish will come in and ask what we charge, ” Drawbert reports. “We are able to take someone who does not have insurance and will do the procedure for less—depending on the needs of the patient. We have to run it through the business people first and make sure that it is fair for the patients and everyone else.” Drawbert added that he has gotten “some nice furniture from them.”
A native of Florida, Drawbert received his medical degree from the University of Wisconsin and did a sports medicine fellowship in Salt Lake City. He is the team physician for the University of Wisconsin at Eau Claire and he and his partner have a sports medicine program that takes care of students at about 20 local high schools. He is a boyish 56 years old, with a full head of brown hair and a slim mustache. Married and a father of three, he moved to Eau Claire in 1986, planning to stay for a couple of years before moving to Madison. He has since fallen in love with the Eau Claire community and plans to remain here for the rest of his professional life.