Moving Forward in a Rapidly Changing World: Jefferson Update
More than 3,000 employees and physicians attended the second series of meetings,
in Center City "Moving Forward in a Rapidly Changing World: Jefferson
Update." (Ford Road Campus meetings have been scheduled for April.)
They heard senior managers talk about the changes Jefferson is making to
ensure that we can continue our patient care, teaching and research missions
while maintaining our standards of quality as well as our financial stability.
What follows is a synopsis of these meetings and a review of frequently
Jefferson Health System (JHS)
Employees heard that Jefferson is moving forward in its strategy to develop
an integrated healthcare delivery system. The hospital separated from the
University on March 1, and became Thomas Jefferson University Hospital,
Inc., with Thomas J. Lewis as chief executive officer. This separation allows
the hospital to fully participate as a member of JHS. While the University
and Jefferson Medical College will be separate from the Health System, they
will still be strategically linked to continue our academic and research
Administrative details, such as new forms, separate purchasing systems and
payroll will be worked out over the next months.
In addition, 15 integration teams with approximately 60 participants from
Main Line Health and Jefferson are looking at ways to operate more efficiently.
Continuing discussions with Riddle Memorial Hospital and West Jersey Health
System move us toward JHS's goal of bringing into the system institutions
that are compatible and can provide the levels of care needed. The hospital
is also looking at developing closer affiliations with Methodist and Pennsylvania
Likewise, the Jefferson Cancer Network continues to develop with the recent
addition of Pennsylvania and Underwood hospitals.
A priority of Jefferson Health System is to develop an integrated information
technology capability. We are working to coordinate selection of a primary
software vendor shortly and have narrowed the selection process to two finalists.
We need to ensure that patient identification and sharing of data can occur
easily between JHS members.
Significant progress has been made in:
- improving network access and performance
- developing a clinical workstation model
- coordination of common patient registration, physical practice management
system and cost restructuring.
A key component of our success in developing an integrated healthcare delivery
system is the commitment of our physicians, who recommend Jefferson's services
to their patients and who support our delivery of quality care. In Philadelphia
and throughout the country, there has been a great deal of movement of physicians
between different healthcare organizations ­p; another sign of the rapid
change we are experiencing in the healthcare industry today.
While several doctors have decided to leave Jefferson to work with other
academic healthcare centers, Jefferson has also been able to recruit new
physicians with highly respected and well-established practices; and we
are actively pursuing primary care and specialty practices.
Jay Sial has been hired as JeffCARE administrator, and Stanton Smullens
MD, has been named CEO.
- The Jefferson Faculty Foundation (JeFF) has recruited 20 new physicians
and anticipates having 30 to 35 new members in FY 97, including 28 primary-care
physicians as well as new specialists. In addition, the Foundation is actively
supporting the developing of JeffCARE, Jefferson's physician hospital organization(PHO),
with representation on the JeffCARE board.
- JeffCARE, Jefferson's PHO, works on behalf of:
- the University's teaching hospital
- the employed clinicians who practice medicine as a part of the Jefferson
Faculty Foundation; and
- the attending physicians who are volunteer faculty members to secure
contracts for Jefferson to provide clinical services to managed care organizations.
To date, full-time faculty and more than 100 volunteer faculty are enrolled
The Jefferson-Affiliated Management Services Organization (JAMSO) provides
practice support and management expertise to 13 practices and 24 primary-care
physicians, as well as 2 practices and 3 specialists, and is actively working
Admissions are down 3 percent and patient days ­p; the number of days
that patients stay in the hospital ­p; are down 8 percent compared to
our projections, and these decreases are occurring much faster than we had
projected. Federal and state funding continue to decrease, and competition
for our services continues to increase. In addition, a Ridge administration
proposal would cut state appropriations to Jefferson Medical College in
half and would leave a large number of current Medicaid patients without
To achieve our cost-reduction goals, we must look across the organization
at ways we can provide healthcare services more efficiently.
Ten design teams have been meeting regularly since the beginning of the
year to evaluate various opportunities for cost savings and process redesign.
In addition, we are looking at organizational structure, capacity management
and benefits. Cost restructuring is an enormous effort, and we are very
grateful for everyone who has contributed to it.
The idea approval process includes idea submission by the team, a cost/benefit
analysis, department input, submission for Steering Committee approval,
and then the idea moves to the implementation phase.
Our initial goal is to identify $25 million in cost savings by July 1. As
of March 8, the Steering Committee has approved suggestions for a projected
savings of $10 million. Even if you are not participating on a design team,
you still can make suggestions for cost reductions and efficiencies. A suggestion
form was included in each hand-out packet. Additional forms may be obtained
by calling 5-9504.
To redesign many of the processes and procedures we use to do our work,
subgroups of teams are looking at activities such as documentation, medication
administration, lab testing and patient care delivery to see where things
can be done more efficiently. (See chart below).
Cost restructuring is a long term effort which is requiring many difficult
decisions. Jefferson is taking a new look at everything we do and how we
do it. Clearly, positions will be eliminated and many of our jobs will be
different than they are today. This type of change is stressful and can
affect our ability to work well while it is taking place. It won't be easy,
but this is the most effective way to preserve Jefferson's strengths.
New organizational structure guidelines recommend:
We are continuing to look at human resources programs to support the cost
restructuring activities, including voluntary separation programs and review
of retirement, compensation and benefit programs. We also have an agreement
with Main Line Health System to give preferential consideration to employees
who are laid off during this process.
- four levels of management, between nonsupervisory employees and senior
- a ratio of one manager for 12 employees.
To respond to the current trends in admission and patient days we have eliminated
200 full-time equivalent positions as of April 1. This translates to laying
off 135 employees at all levels throughout the institution, with the rest
being positions that are currently vacant. This will provide $9.4 million
in annual cost savings. Severance packages and outplacement assistance are
being provided for affected employees.
This was a very difficult action for us to take, as it affects many people
around Jefferson both directly and indirectly. Because the pace of change
in healthcare is accelerating even faster than we had anticipated, we must
respond quickly in order to preserve our ability to effectively deliver
care over the long term.
There is a team monitoring activity to align our capacity with the current
trends; and a number of the initiatives we have outlined, such as new physician
linkages, are designed to contribute to improving numbers of admissions.
Moving Forward in a Rapidly Changing World
While we are in the midst of a great deal of activity and change, Jefferson
has experienced a number of turbulent periods during our 175 years. But
Jefferson has survived and survived well throughout them all. These are
difficult times, but they also ultimately can be exciting times as we face
the challenges of maintaining our mission in a new era of healthcare delivery.
To ensure our continued success:
If we succeed at these things, we have every reason to believe that we will
continue to sustain our outstanding heritage and our mission of quality
patient care, academic and research excellence, and community service.
- We must continue to improve our ability to act quickly and decisively,
recognizing that we will make some mistakes along the way.
- We must communicate as much as possible and develop the tools to deal
with the changes as effectively as possible.
- We all must recognize the need to change, and be willing to behave and
do work in new ways in order to respond to the future.
Please use the hotline (955-1799) as well as e-mail and the Thomas "ANSWERS"
system to ask any questions you may have.
As part of the process, we have defined the current culture at Jefferson
and envisioned the new culture that we need to succeed. Please note the
differences in the old and new cultures as well as the things that need
to be maintained:
Long decision time frames
Strong hierarchical structure
Process-oriented with emphasis on conformity
Quality of care
Mission of education, research and service
Participation with direction
Sense of urgency
Focus on results, risktaking
Quality of care
Mission of education, research and service
TO ANSWER YOUR QUESTIONS
Q. How can we ensure that patient care won't suffer with all this change?
A. We have always been committed to maintaining high standards of patient
care, and that commitment is not changing. In fact, many of the initiatives
we are undertaking are designed to enhance patient care and satisfaction.
What is changing is the way we deliver patient care, to ensure that we are
using all of our resources most efficiently and cost effectively.
Q. What are our competitors doing? Are they experiencing the same problems
A. Up to this point, Jefferson has not had to go through the severe changes
that a number of our competitors have. Jefferson is experiencing and responding
to the same challenges as all of our competitors, which are particularly
attributable to the shortened length of hospital stays. There are many different
strategies and no one formula guarantees success in healthcare delivery
today. A number of our competitors have been taking a more short-term approach
to the current environment by concentrating on acquiring physician groups.
Jefferson has not pursued this strategy as strongly, instead focusing on
the full continuum of care. However, we have continued to adjust our strategy
to the current trends and needs, and we are dedicated to developing a regional
presence for the Jefferson Health System.
Q. Will layoffs be used to fund HealthLINK and other new projects?
A. We are not looking at job eliminations as a direct source of funding
for any of these initiatives. Rather, we are identifying areas of our organization
that require more or less investment and resources going forward. Any changes
to or elimination of jobs will be a result of a thorough study of the work
performed in that area now and as we see it in the future. However, we must
also recognize that achieving our mission requires doing new things, and
these new initiatives often require significant capital expenditures. We
must be concerned with managing the "bottom line" of our business
in order to ensure that we can continue to deliver our services effectively.
Q. What portion of the $75 million cost reduction goal is going to be
reductions in labor?
A. The cost restructuring and process redesign effort is designed to look
at the way things are done, and make recommendations as to what things can
be done differently to be more effective. Because we are in a people-intensive
industry, a majority of our expenses are labor. However, we continue to
look at vacant positions and attrition as much as possible.
Q. What are the criteria for choosing job eliminations ­p; seniority?
A. Job eliminations will be based on performance first, and then seniority,
other than where the criteria are defined by contract.
Q. What is being done to keep up morale during this period of change?
A. While we understand and appreciate the stress that uncertainty poses
for you and for us, we do not have definitive answers and are unable to
predict what the future holds for all of us. Please be assured that we will
keep you updated on developments that affect you. We encourage you to take
advantage of programs offered through the department of human resources
and the Health Awareness Program.
Q. When will the new model for patient care delivery be developed? How
will roles change as a result? Will there be retraining so existing employees
can have a job in the new organization?
A. One of the major tasks of the Care Management design team is to look
at the way in which patient care is delivered, and how we need to be staffed
in the future to deliver care. Currently, the goal is to develop a new model
for patient care delivery by the end of May to present to the Steering Committee
for review. We do not have a predetermined model going in to this process.
Once the new model has been reviewed and approved, we will identify what
changes need to be made in terms of staffing. The full implementation of
a new patient care model will take a number of months with very detailed
project plans and input from the affected areas. We will continue to keep
you informed in On the Horizon as progress is made and plans are developed
in this area.
Q. What ideas from the design teams have been approved so far?
A. The teams first concentrated on what we called "Just Do It"
ideas, focusing on things like eliminating vacant positions, management
of supplies, and bidding for outside services. Now we are beginning to look
at more complex ideas and work redesign concepts. As an idea is approved,
an implementation team will be formed, and we will communicate approved
ideas to you periodically in On the Horizon.
Q. Will benefits be cut or changed?
A. We have no immediate plans to cut or change benefits. A team has been
formed specifically to review all of our benefits plans as a part of this
process. We will update you on this over time.
Q. Will there be an early retirement plan or voluntary severance?
A. We are looking at offering a number of different voluntary separation
programs. Some programs may be offered only in specific areas, and/or at
specific times, to respond to particular staffing changes or needs.