EDITORIAL: What’s next for CMH?

ON A PERFECT DAY for a picnic, a couple of hundred hospital employees, who could leave their posts, gathered at noon in the parking lot of Columbia Memorial at the hospital’s invitation. Some had heard rumors that the independent, locally controlled, non-sectarian, non-profit hospital was about to be swallowed up by some bigger competitor, a national chain or maybe space aliens.
The rumors had it all wrong, said Jane Ehrlich, who has served as the CEO and president of the hospital for 18 years. Far from selling out, Columbia Memorial Hospital (CMH) expects to grow bigger and expand its services to meet consumer demand. Coming from her, it’s not an idle promise. People who’ve watched the hospital over the last couple of decades acknowledge that she’s led what amounts to an astonishing turnaround in the quality and quantity of local healthcare services.
The party tents, fresh health foods and hospital brass were all part of a coordinated program to announce that Ms. Ehrlich is leaving her post at the end of the year and her replacement is her deputy, hospital Chief Operating Officer Jay Cahalan. The employees present at the noontime announcement applauded word of Mr. Cahalan’s promotion, which will make him head of the largest private enterprise in the county. Some were undoubtedly relieved not only by the continuity his appointment represents but also at the definitive word that CMH is not for sale.
This apparently smooth and credible transition won’t reduce the pressures on the hospital and its various satellite healthcare ventures. But Ms. Ehrlich deserves the credit for reinventing CMH as an ambitious provider of services, creating in the process a virtual monopoly locally on traditional medical care.
One hospital executive Tuesday rejected the notion of CMH as a monopoly, noting that patients in Columbia and Greene counties don’t have to go to Columbia Memorial for medical care. They can choose instead from hospitals in Albany, Kingston, Poughkeepsie, Pittsfield, or, for non-urgent matters, New York City or Boston. Some do.
But medical consumers often look for providers close to home because they’re more convenient or less expensive or because the wait times to see a local practitioner may mean you won’t die before your next appointment. In any case, when a hospital, by its own estimate, employs 90% of all the practicing physicians in the counties it serves, as CMH does, that’s a form of monopoly. It’s also a smart strategic move that forces competitors to think twice before trying to horn in on this market. But will it improve the care we get?
In theory it can, if the hospital finds ways to advance patient safety and “outcomes”–the medical industry term for measuring whether patients leave the hospital healthier than when they arrived. Columbia Memorial has taken a lead in the region on patient safety. The hospital has also invested heavily in new equipment and in recruiting doctors with impressive credentials as specialists. It has also earned certification as a stroke care center, a good thing considering that the population of Columbia County is older than most other counties in the state.
This will all be part of Ms. Ehrlich’s legacy when she retires at the end of the year, leaving Mr. Cahalan with the task of building on the progress already made. He also faces another, even more daunting job that could define the future of the hospital: He has to figure out why CMH doesn’t get the respect it will need to thrive.
The 2011 Hospital Report Card produced by the independent, non-profit Niagara Health Quality Coalition, ranked hospitals around the state. The results are available at myHealthFinder.com. To the layperson, it looks like Columbia Memorial earns good to average marks on many medical procedures. Then there are “patient survey results,” and while patients rank the hospital at the national average for specifics like pain management, communication with doctors and nurses and “cleanliness,” when patients are asked to give this hospital an overall rating, they hammer the place with a mark below the national average.
All the great work that Ms. Ehrlich, hospital employees and the board have accomplished during her 18 years here still have not dispelled outdated attitudes about the hospital’s inadequacies. She has laid the groundwork for a change in perception as well as in performance, but until the hospital overcomes a mindset that imagines an old hospital where a new healthcare organization exists, her work isn’t finished. That’s the real challenge for Mr. Cahalan.

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