Motality & hospital report cards

Two years ago I was concerned about pneumonia cases. A large insurance company released an updated version of its report card on hospitals, and for the second year in a row CGH statistics were good in all areas – except pneumonia. According to the insurer, the death rate from pneumonia at CGH was more than it should be when compared with the Central New York region.

What was the cause? Were CGH patient records properly coded?[1] An outside review of our records showed that we were accurately coding them.

Was CGH care being provided properly? Yes, it was. We reviewed every single case.

Were pneumonia patients at CGH somehow different from those at other hospitals? We looked at the numbers of patients transferred to CGH from nursing homes. We looked at the average age of pneumonia patients. CGH pneumonia patients were somewhat older than those in other hospitals. On average the CGH patients were 75 years old. The average age of pneumonia patients at other hospitals ranged from 50 to 69 years. Still, age alone did not explain it. We were puzzled.

The quality committee that was reviewing our pneumonia care focused its attention on advance directives.[2] One form of advance directive is a DNR order (“do no resuscitate” order). Patients with DNR orders request not to have cardiopulmonary resuscitation (CPR) under certain circumstances.

When we examined the records of patients with pneumonia who died at CGH, we found that that 90% of them had DNR orders. In other words, most deaths were by patients who did not want aggressive efforts to resuscitate them if their conditions seriously deteriorated. Of the hundreds of non-DNR pneumonia patients cared for at CGH, the death rate was less than one percent.

This distinction was apparently not reflected in the analysis used by the insurance company for its hospital report card. This point was clearly demonstrated last year when Dr. Dan Carlson, Vice President – Medical Affairs, and I attended a meeting on hospital report cards with about a dozen upstate hospitals. The large insurance company showed pneumonia mortality rates that it prepared for hospitals attending the session – and, sure enough, CGH appeared to have an above average mortality rate. Next to present was a national company that also produced quality comparison data. In this case, however, CGH was shown to have a lower mortality rate than the other hospitals when adjusted for more patient risk factors. Both presentations used the same data to generate different hospital rankings, based on their different statistical methods.

I was reminded of our pneumonia investigation when I read “Informed Choices For Better Care,” a recent story in the Post-Standard. The story said that for many years patients and families were “kept in the dark” about hospital comparison information, but report cards are now letting “consumers shop for health care much the same way they do for cars.”[3] The article also quoted the publisher of one hospital report card as saying that “hospital special interests” may no longer claim that “those poor dumb yokels (the general public) couldn’t possibly decipher how to use hospital data.”[4]

That report card publisher apparently sees hospitals as an adversary, but CGH has supported the development of report cards for many years (and we never disparaged the public as “dumb yokels”). In the 1990’s CGH was the first and only upstate hospital to publish its own comparative quality report card.[5] In doing so, CGH consulted the literature on quality reporting, used available data from national studies, and conferred with state government, local health maintenance organizations, and national organizations on the design and data used in the CGH report. This was before insurance companies and the federal government developed their hospital comparison websites.

Hospitals are not perfect, and neither are report cards, as the above pneumonia example suggests. I would argue, however, that website report cards educate both the public and providers, and they encourage competitive hospitals to get better. These are important tools in helping the health care industry make continuous improvements in quality management.

The pneumonia example demonstrates how seriously CGH investigates itself. I believe all hospitals take variations in quality seriously, and as the tools for measurement get better, hospital results will improve too.



[1] The government and payers look at the disease codes assigned to each patient record – this forms the basis for analysis.
[2] Advance directives are the written instructions patients give to doctors and hospitals specifying the type of care the patients want to receive (or don’t want to deceive) in the event they cannot make future medical decisions for themselves.
[3] “Informed Choices for Better Care,” Post-Standard, May 9, 2005.
[4] Post-Standard, May 9, 2005
[5] CGH’s self-published Quality Report Card started in 1996. It was posted on the CGH website and was issued annually until 2000, when the internally-prepared documents ceased when CGH joined the Health Alliance of CNY. In 1999 CGH’s report card cited with approval the Report of the President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry (1998): “A widespread and ongoing consumer education strategy should be developed to deliver accurate and reliable information on quality when choosing health plans, providers, and treatments.”

Passport to the Future

On the evening of May 19 last year, representatives from CGH and other Syracuse hospitals gathered in an auditorium on University Hill as a Harvard physician gave us a glimpse of the future.

Dr. John Halamka, the Harvard physician, operates the information systems that link the medical records of all patients in a 21-hospital system in the Boston area. We watched as he connected into his system, and the image from his computer was projected on a screen. He showed us how a doctor can sit at a computer anywhere and, through the internet, see the list of his hospitalized patients. Some patient names have flags indicating new test results or highlighting abnormal tests that need the doctor’s attention. The physician can click on each patient name and see each patient’s information. The doctor can easily change a patient’s medications or write notes in the chart, all from the computer. The system automatically reminds the doctor of care standards and potential drug interactions.

Dr. Halamka showed us the future.

At most hospitals patient information is still very much a paper process. Hospitals may have advanced clinical equipment, but when it comes to information management, most of us still use paper technologies that have more in common with the 19th than the 21st Century.

Even when we have computerized information, it is usually in stand-alone systems that are not easily linked. For example, the CGH radiology system is separate from the CGH pharmacy system, and each is separate from the CGH patient registration system. With isolated systems, it is very difficult for doctors to check on their patients. With isolated systems, patient information and identification numbers are entered manually on multiple occasions, increasing the opportunity for error. To review patient information, CGH doctors currently use multiple passwords and different codes to get into these separate systems, each with its own report on the same patient.

Two weeks ago President Bush was in Ohio[1] to highlight health care information technology as “essential to improving America's health care system.” The White House news release said that, although information technology has transformed industry, hospitals have yet to realize the full benefits of the digital age. As a result, it said there are

serious concerns about high costs, avoidable medical errors, administrative inefficiencies, and poor coordination – all of which are closely connected to the failure to incorporate health information technology into our health care system.

CGH is about to take one giant step into the next generation of information technology. Next week our Board of Directors will review new technology to link our stand-alone systems. This will be a major advance, and the changes in the coming months and years will affect many areas of our hospital.

CGH was the first hospital in Syracuse (and one of the first nationwide) to implement a pharmacy robot some ten years ago. Since then we’ve seen the addition of computerized drug-dispensing units in patient care areas, new x-ray and pharmacy systems, a speech-recognition dictation system – and this year we will add a new surgery system.

What is the new technology being planned? CGH will begin to develop an electronic medical record, and we will install a new “portal” to allow physicians to see on computer the list of their hospitalized patients. CGH doctors, using a single password and code, will be able to see patient test results, to readily identify abnormal values, and to enter orders directly into the system, even from their offices or homes. When these changes are complete, doctors on our medical staff will be able to do many of the things we saw demonstrated last May.

Linking CGH’s stand-alone systems through the “portal” will go a long way to making patient information more available and easier to use. And the true beneficiaries will be our patients. These systems will improve patient safety because they reduce the risk of misidentification and the risk of medication error.[2]

President Bush has set a ten-year goal to assure that most Americans have electronic health records. The electronic records would be able to share information privately and securely among health care providers. There’s a lot of work to achieve that national goal. Even the Boston system we saw in demonstration links providers within a single hospital system and cannot communicate with outside doctors or hospitals.

The review with our Board next week will be a first step. Acquiring these systems represents a commitment of millions of dollars over several years, a significant investment for our hospital.

The new technology will represent more than a “portal” for physicians and additional safety protection for patients. The new technology will be CGH’s passport to the future: when the nation is ready to share medical information among hospitals and doctors as the President has proposed, CGH will be prepared.


[1] On January 27, 2005, the President appeared at the Cleveland Clinic.
[2] “CPOE systems can be remarkably effective in reducing the rate of serious medications errors,” according to The Leapfrog Group, which is made up of more than 160 companies that buy health care services. The Leapfrog Group seeks to reduce preventable medical mistakes and improve the quality.

Brahm's lullaby announces each birth

What a wonderful event! On December 14 Congressman Jim Walsh and his wife, DeDe, helped cut the ribbon to dedicate the new Family Birth Center that is named after them. The Walshes were joined by the Snyders. Wendy Snyder gave birth to each of her three children at CGH, and she is expecting her fourth in February.

At the ribbon-cutting were, from left, Dr. Howard Weinstein, Chair, Department of OB/GYN; Christine O’Connell More, Chair, Community General Foundation; Congressman Jim and DeDe Walsh; Rob Snyder with son Joshua and daughter Katherine; Wendy Snyder with daughter Anna; myself; and Steve Infanti, Chair, Community General Hospital.

The new center is filled with special touches, from wood trim to frosted glass side panels, each with a decorative rose. The bathrooms have tile floors and whirlpool baths. Linen shelves may be stocked from outside each room, and each laboring mom will have a soft bathrobe. There are three triage rooms, six LDR rooms (labor-delivery-recovery), and two rooms for C-Sections.

Another special feature of the new center is a recording that announces the birth of a baby to the entire hospital. At the dedication ceremonies Laura Smith, LPN, demonstrated the chime recording of Brahms' Lullaby. Mrs. Smith, who with Dr. Weinstein unceremoniously raised a hammer last spring to start the demolition of the old unit, has been a CGH employee in Labor & Delivery since December 26, 1962 – five days before the first baby was born at Community Hospital.

Our thanks to the US Government for the $1 million grant secured by Congressman Walsh, and to the donors of some $338,000 in additional funds that have been contributed to the birth center. The total cost is $1.9 million, and donations are being accepted by the Community General Foundation’s “Pay it Forward” capital campaign.

Thank you, all!

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This text was originally sent to the employees of Community General Hospital, Syracuse, NY, as one of a series of letters from the CEO. The text was subsequently posted on the CEO's blog, More than Medicine, started in June 2007.

The quiet hand

We see the good they do all around us, but we may not recognize it as the quiet work of the Auxiliary to Community General Hospital. At the 42nd annual meeting of the Auxiliary last Thursday (October 27), Dr. David Simon, Medical Staff President, gave an example of their quiet deeds.

Dr. Simon had seen patients that morning at Van Duyn Home and Hospital, our campus neighbor across the tree line. In conversation with a head nurse at Van Duyn, he mentioned that he would be speaking with the Auxiliary later in the day. The head nurse told him gratefully that, years ago, the Auxiliary helped her become a nurse through its scholarship program. Each and every year Community's Auxilians volunteer interview candidates and make scholarship awards. Over the years they have helped many join the nursing profession.

How many of us use the Gift Shop for snacks, sundries, and gifts for patients? The Gift Shop is an Auxiliary project that requires many volunteer hours for ordering, inventorying, transporting, and staffing. At the annual meeting Carol Merritt, Auxiliary President, paid special tribute to Bob Easton, who has quietly run the gift shop for decades. She also acknowledged Walt and Vera Sassman, two Auxilians who have volunteered at Community – Vera for over 40 years, Walt for more than 35. Monday was their last day as volunteers. “But we are still members of the Auxiliary,” they hastened to tell me.

In his remarks to the Auxiliary, John Scala, Director of Volunteers, cited more examples of the Auxiliary’s quiet hand in the life of Community. He spoke of Auxilians’ work in maintaining the flower beds that make the front of Community General Hospital so pleasant; he spoke of the Light-a-Light program that decorates the campus and helps families and friends honor their loved ones during the holiday season; he spoke of the Auxiliary’s annual golf tournament, its fashion show (coming December 3), and the sales events throughout the year that help employees, volunteers, physicians, and visitors shop for books, toys, clothing, linens, flowers, and jewelry.

Auxiliary fund raisers contribute to the life of our hospital, and they generate funds the Auxiliary donates for hospital care. Last Thursday Carol Merritt presented the Community General Foundation with a very generous $45,000 check for Community's new Birth Center.

Here is something quite remarkable – the Auxiliary’s gifts to the Community General Foundation’s “Pay it Forward” capital campaign more than equal the gifts from hospital directors and employees. The Auxiliary has contributed $150,000 to “Pay it Forward,” and to date Community's board members, managers, and employees have pledged and contributed some $143,000. That shows just how busy – and just how generous – are the Auxilians.

If you're doing the math, you’ve noticed that the Auxiliary actually predates our hospital. The Auxiliary’s annual meeting was its 42nd. Community General Hospitalwill celebrate its 42nd anniversary on January 1st. Dr. Simon noted that the Auxiliary became active before Community opened when the first Auxilians went door-to-door, inviting others to join them. The newly-formed Auxiliary led tours of the hospital for community groups in the months leading up to Community's opening on January 1, 1963.

The Auxilians are a big part of our hospital’s past and, as is evident, a big part of our present. In my remarks to them, I thanked the Auxilians for their constancy, and I assured them that we who work for Community are grateful for all they do. I promised that, for our part, we will continue to value, care for, and respect each patient, every day.

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This text was originally sent to the employees of Community General Hospital, Syracuse, NY, as one of a series of letters from the CEO. The text was subsequently posted on the CEO's blog, More than Medicine, started in June 2007.

On memorial Day

Outside the Diagnostic Center (in front of the Admitting Office window) is a dogwood tree, identified by a small plaque that honors the memory of Lt. Patrick Kelly Connor, USN, who died in the Gulf War in 1991. Marsha Connor, an OR nurse who retired from Community General Hospital last year, is Patrick’s mother.

I noted the plaque on rounds this morning, especially because this is the Memorial Day weekend. As a national holiday, Memorial Day is celebrated on Monday, May 31, but the traditional date is May 30.

Memorial Day reportedly has its roots in 1863, when the Civil War was being fought. Women in Columbus, Mississippi, decorated with flowers the graves of Confederate war solders, then showed the same respect to the nearby graves of Union soldiers. In 1866, following the War, a drugstore owner in Waterloo, NY, closed his store on May 30 as a sign of respect for the war dead, and the tradition of Decoration Day – later Memorial Day – began. By 1882 Memorial Day was observed for the first time as a national day of remembrance for those who died in the nation’s wars.

Continuing on rounds, I observed other memorial plaques honoring those who have worked and volunteered at Community General Hospital.

In the lobby next to the flower display is a plaque that commemorates the 1982 dedication of the flagpole. “The flag displayed in front of Community General Hospital,” it reads, “honors the memory of all deceased hospital employees.” The pole was erected by Radiology Department employees who had lost one of their co-workers, Vera Snyder, that year. I recall from that dedication that the first flag to fly at Community had previously flown above the nation’s Capitol.

There is a plaque on Four North honoring the memory of Ann Gibbs with the statement, “Through these halls have walked the best.” A sign honors the memory of the Rev. Kevin Joseph Murphy on Six East, and 20-year volunteer Gordon Ketchum is also remembered with a plaque recently placed on Six. There is a bench in honor of volunteer Pat Berical outside the Diagnostic Center, and next month the Auxiliary will dedicate a bench to honor long-time volunteer Carolyn Boshea, who recently passed away.

The main lobby displays the plague remembering John L. Brown, our “first administrator, first employee.” Numerous memorial gifts are commemorated in displays throughout the hospital, many dating from the original construction. Family and friends have made donations to our hospital from the very start to honor their loved ones. All we have to do is look - all around us are tributes to those who came before.

We truly honor the memory of the nation’s war dead, and the memories of Community founders and colleagues, in the work we do for our patients today, on Memorial Day, and every day.

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This text was originally sent to the employees of Community General Hospital, Syracuse, NY, as one of a series of letters from the CEO. The text was subsequently posted on the CEO's blog, More than Medicine, started in June 2007.

What they say

Community General Hospital was one of 132 hospitals nationwide that voluntarily participated in a patient survey undertaken by the federal government last year. The Centers for Medicare and Medicaid (CMS) conducted a pilot project involving 61 hospitals in New York, 45 in Maryland, and 26 in Arizona.

CMS will use the project to develop a standard way of evaluating hospital performance by patients. When the project is finished, we can expect CMS to look for ways to link the how hospitals are paid to how well patients rate their care.

The CMS surveys were conduced on Community's medical-surgical patients who were discharged in December 2002 and January 2003. For obstetric patients, the sample was drawn from patients in the November 2002 and January 2003 period. Patients received a pre-survey letter, a mail-in questionnaire, and a thank you card. Those who did not return questionnaires received up to five follow-up telephone calls to improve the response. As a result, of the 900 Community patients who were surveyed, fully one-half responded (49.9%).

Patients were asked to score the hospital from 0 to 10 with 0 being the “worst possible” hospital experience and 10 being “best possible.” 35% percent gave Community a “perfect 10” and 63% scored “9 or 10.” Most people had very good experiences here, but surveys like this one help us focus on improving performance by using information from those who rated us less favorably.

The CMS survey results also suggest how we compare with other hospitals in the state and nation. For example, on the “worst possible/ best possible” question, 59% of the patients scored “9 or 10” among the 61 New York hospitals that participated.

We looked at another survey this week at a meeting of the Medical Executive Committee. That survey, conducted at a recent meeting of the Medical Staff, helps us understand physician opinion. This is a snapshot of the views of the doctors on whom we depend for patient referrals and medical management.

In all 52 physicians completed the survey, and they said the quality of physician care at Community is comparable to other hospitals – one-fifth reported it as “better.” Only 2% forecast a decrease in their work at Community with 23% saying they anticipate using Community more in the future.

One question asked: “Is Community's image in 2004 better, worse or the same as 2002?” In reviewing the results this week, one Department Chairman said he was pleased that 69% of the doctors think our image improved. “And I think that’s right,” he said. “Community is better.”

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This text was originally sent to the employees of Community General Hospital, Syracuse, NY, as one of a series of letters from the CEO. The text was subsequently posted on the CEO's blog, More than Medicine, started in June 2007.

An old friend

We made a little history this week. The top management team from Van Duyn Home & Hospital sat down with senior management at CGH. It was a “first” for both administrations. None of us at the table could remember when the two administrations met as a group. We are not sure why we never met, but all agreed it’s a good thing to do.

Van Duyn traces its roots to 1827 when Onondaga County established a Poorhouse on Onondaga Hill. During the 1800s the county operated the “poorhouse,” an “insane asylum,” and “the county farm” on acreage that extended to the present Onondaga Community College (OCC) campus. In 1900 the sick residents were separated from the indigent residents, and the County Home and Hospital was established. In 1916 a sanatorium for tuberculosis patients was created on the site Community General Hospital now occupies. In 1959 New York State closed the sanatorium and transferred the buildings and 60-plus acres to Onondaga County (where Van Duyn now stands). The state also deeded the adjacent 42 acres to the Community Fund (for Community General Hospital). In 1954 the County Home and Hospital was renamed to honor Edward S. Van Duyn, MD, its respected medical director. In 1963 CGH opened its doors.

So CGH and Van Duyn have been neighbors on Onondaga Hill for 40 years. People often mistake Van Duyn’s large white façade, visible from Route 81, as Community General. And some visitors to Van Duyn find themselves in the CGH traffic circle wondering why there are no “Van Duyn” signs.

CGH purchased steam from Van Duyn until we built our own steam plant in 1999. Nursing staffs, social workers, and case managers talk frequently as they coordinate care for the many patients we have in common. This past summer Dale Parsons, Commissioner of Long Term Care, and I met several times to discuss road changes being planned for the CGH campus by the New York State Department of Transportation. Once we started talking about roads, we wondered why our management teams never actually sat down together.

The road conversation started because the New York State Department of Transportation (DOT) needs to eliminate the dangerous left turn at Seneca Turnpike as cars exit from the Van Duyn property and from our own “Woods Road.” The state will eventually ban left turns there. The state planned to require all city-bound traffic from Van Duyn to use a new road that would extend from Van Duyn property directly across CGH’s south “G” lot. This would have created a third intersection with CGH at Broad Road.

As you can imagine, our Broad Road neighbors were not very happy to learn of a third intersection with hospital property. That’s when Don Hamilton, a member of the Onondaga Town Council, asked CGH to consider an alternate route on our campus. Mr. Hamilton is also a neighbor. He lives on Elgin Drive and takes walks on the CGH and Van Duyn campus. Mr. Hamilton arranged for us to meet with County officials, and we agreed cars should use the existing traffic pattern, rather than cut a new intersection into Broad Road. As a result, Onondaga County arranged a big meeting with state DOT for officials from CGH, Van Duyn, and the Town of Onondaga. I am happy to say the state DOT accepted the change and has redrawn its plans. The new road will not cut across “G” lot. Instead, the new route will extend from Van Duyn road along the CGH tree line. It will intersect with the existing “G” lot driving lane and will use the existing intersection with CGH’s main road.

This will require DOT construction on our campus as the roads are upgraded to official standards. When construction is completed, the county will assume responsibility for the new route through CGH’s “G” lot and along part of our main road. For the most part, the new road will use the existing traffic pattern, but we will see changes in road construction, corners and signage next year.

As we discussed the road project, Mr. Parsons and I started talking about other things we might work on together. From there it was a short distance to “let’s get the management teams together.” So last Thursday the CGH vice presidents met with the Van Duyn administrative and medical leaders for coffee and cookies and interesting talk. How can we help our patients by facilitating communications about DNR or end-of-life issues? Can we learn from one another on ways to better manage certain costs? What about supply or energy savings? I’m not sure what will come from our talks, but we are actively interested in the things we might do together.

Sometimes you know a person for many years before you really open up to one another and build a friendship. It’s good to see CGH’s friendship growing with our nearest neighbor, Van Duyn.

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This text was originally sent to the employees of Community General Hospital, Syracuse, NY, as one of a series of letters from the CEO. The text was subsequently posted on the CEO's blog, More than Medicine, started in June 2007.

The good, quiet work of CGH people

Fourteen employees hold confidential meetings from time to time throughout the year. They are acting for all of us in helping employees, retirees, and volunteers who are facing a crisis of one kind or another.

The fourteen employees[1] are members of the “CGH Employee Community Service Fund” – the same group that conducts our United Way campaign each fall. While raising funds for the United Way, the Fund also receives gifts to help co-workers in family emergencies.

Fund members usually meet in private to discuss the circumstances of those who may need assistance. Anyone, however, may attend the Fund’s annual meeting, which was held on February 12. The annual meeting is used to report on activities and answer questions about the Fund.

In 2003 the Fund distributed $26,331 to the United Way, helping charities across Central New York. It also distributed $12,725 in financial assistance within the CGH family.

Who benefits from such assistance? They may be co-workers, retirees, or volunteers who face an immediate family hardship caused by a problem with a spouse, a work interruption, the loss of child support payments, illness, fire, or death. Such events sometimes create dire situations for families.

Some employees apply to the Fund directly (applications are available in the Human Resources Department). Sometimes co-workers may ask the Fund to consider assistance in difficult situations they know of. The Fund assigns one of the fourteen members to meet with the individual and thoroughly review the situation. This is often difficult because it may involve embarrassment or emotional distress. So the Fund limits contact to a single member who keeps confidential the applicant’s name.

The Fund considers each situation on its merits. Often it asks for more information, including copies of bills or other documentation. Sometimes an individual may be asked to use the Employee Assistance Program that is available without charge to all employees. The Fund may also want assurance that an applicant has started to manage a bad credit experience and is actively working to improve the situation.

After reviewing the circumstances, the Fund may provide financial assistance to help a family bridge a difficult period. The fund has paid for utilities when cut-off was threatened, for family food and medical expenses, for rent, or for partial funeral costs. There are things the Fund will not pay for, such as cable television or car payments.

The Employee Community Service Fund does not make loans, and some applicants have been uncomfortable accepting such assistance without a repayment agreement. In these cases the Fund has encouraged individuals to repay the amount, when they are able to do so, by making donations to the Fund.

The Fund has assisted members of the CGH family with over $60,000 in financial assistance during its 11-year history. This is the good, quiet work of CGH people that benefits CGH people.

Many thanks are deserved by the fourteen employees who serve on the Fund, conducting interviews, holding the meetings, and keeping its records and accounts. But the ultimate appreciation belongs to all members of the CGH family[2] who support the work of the Fund with their annual donations and pledges.

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This text was originally sent to the employees of Community General Hospital, Syracuse, NY, as one of a series of letters from the CEO. The text was subsequently posted on the CEO's blog, More than Medicine, started in June 2007.

[1] Maureen Blackmeer, John Connor, John Carnowski, Cindy Cress (Past Chair), Tracy Fenner, Kathy Kendrick, Donna King, Toni Maxwell, Sharon McCue, Jim O’Brien, Leah Neider, Phil Sherwood, George Slavinski (Chair), and Jean Waldron. Ken Redmore has recently joined the panel, succeeding Leah Neider.

[2] Last fall 587 members of the CGH family (535 employees, 32 retirees, and 20 volunteers) gave $37,196 to the Employee Community Service Fund to support United Way charities and to benefit our fellow employees in times of need.

Where we came from

In the early morning hours of January 1, 1963, a baby girl was born at Community Hospital, its first patient. Her birth in the brand new hospital was the result of more than ten years of community planning, including two false-starts.

I know something of this history because in 1985 Morris “Morey” Berman, an attorney and one of the founding board members asked me to lunch. I was one of the “next generation” he wanted to know about the “true story” of Community General Hospital. I was fascinated to hear his story then, and as CGH nears near its 40th anniversary, I found myself telling this story last week to doctors and to business leaders. It is a good time to remind ourselves where we come from.

In the 1950’s there were many aged hospitals in Syracuse, NY. Some of them dated from the Victorian era. The names of some hospitals are not heard anymore, so let me recall that Syracuse was home to A.E. Silverman Hospital, General Hospital of Syracuse, Midtown Hospital, Crouse Irving Hospital, Syracuse Memorial Hospital, Peoples Hospital, St. Joseph’s Hospital, St. Mary’s Hospital, and Good Shepherd Hospital.

There were two false-starts before CGH got underway. The first was a community planning report by a committee chaired by attorney Benjamin Shove (1952), the second by Carrier Corporation’s executive Cloud Wampler (1954). Both community leaders chaired studies that made recommendations. Each suggested improvements and consolidations in the city’s hospitals. Each came to nothing.

Then about 1956, Syracuse newspaper editor Alexander “Casey” Jones checked into a hospital on Irving Avenue for abdominal surgery. He found a roof leaking and one or more buckets to collect the water dripping in his room. He was happy and asked for a room change, but there were no other rooms available. So Casey Jones checked out of the hospital, took a train to Washington DC (his home town) and had surgery there. He returned to Syracuse a number of weeks later and sought out Syracuse Mayor Donald Mead. He asked the mayor for help in developing public consensus to replace antiquated hospital facilities.

Mayor Mead called for an investigation by the City Planning Commission, chaired by Morey Berman, my informant. The result was three days of public hearings at which more than 70 physicians, patients, and business people testified about the urgent need for improved hospital facilities. This generated the third community report that called for an entirely new 300-bed hospital to be constructed away from downtown in an area of “therapeutic green.” Several locations were suggested, and among them the 42 acres of reforested land owned by the County on Onondaga Hill. State Senator John Hughes authored special legislation in Albany which allowed County Executive John Mulroy to deed the land for $1.00 to a new Community Hospital.
How to build the new hospital? The Community Fund was created (now, the Community General Foundation). It was chaired by Leonard Markert Sr. who rented space downtown for the meetings and volunteers who traveled throughout the area seeking donations. Within a matter of months the Fund had pledges totaling more than $7 million, the largest fund raising campaign in Syracuse to that time (and for many years after).

Thousands of people participated in the campaign, many of them pledging small amounts to be deducted from their paychecks every week. The payments were received over several years from employees of General Electric, Carrier Corporation, Crouse Hinds Corporation, New Process Gear, and many from other companies. A US government grant of some $2 million was also obtained under the Hill-Burton Act.

The Community Fund looked for an administrator for its new hospital and hired John L. Brown, a New York native who had recently built a new hospital in Rockford, IL. Mr. Brown became CGH’s the first employee and first president. He relocated to Syracuse in 1958 and started the meetings, designs, contracts, and medical staff recruitment that resulted in the opening of a brand-new Community Hospital of Greater Syracuse in 1963. The first Medical Staff President was Irving Erschler, MD. In November 1964, the new Community Hospital merged with the 79-year old Syracuse General Hospital to form Community General Hospital.

As were the 1950’s, ours is certainly a dynamic time for Syracuse health care. The break-up of the Health Alliance in 2002 and Crouse Hospital’s affiliation talks with University Hospital show a health care environment that continues to change.

What would they say to us today, the people who worked so hard to create CGH during the 1950's?

They would tell us that CGH came about as the result of community planning, individual contributions, and hard work – and they would ask us to hold dear to our values, respecting patients, working closely with doctors, and continuing cooperative planning.

They would say, “Never stop trying” and “Keep getting better.”

They would say, “Take good care of the asset we worked hard to bring to this community.”

They would remind us that our place of “therapeutic green" continues as a vital part of the community’s heath care infrastructure.

We hear them.

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This text was originally sent to the employees of Community General Hospital, Syracuse, NY, as one of a series of letters from the CEO. The text was subsequently posted on the CEO's blog, More than Medicine, started in June 2007.

My first "family letter"

It was three weeks yesterday, October 18, that the Board of Directors asked me to serve as CGH’s President & CEO. It is a privilege to have been asked and an honor to serve in this role.

In those three weeks I have had a number of meetings, often more than one, with our Medical Staff leaders, with our Board of Directors, with employees, and with Syracuse area business and community leaders. In these meetings I am asked similar questions:

- “With all the changes in the health care field, what is the best role for CGH in our community?”
- “What is CGH working on?”
- “Will an emphasis on financial performance hurt quality?”

These are important questions, and I want to be available to you for meaningful discussions about these and other notable issues. Obviously there are many who need to hear from me about such topics, just as I need to hear from you and from those outside our hospital.

One timely way to communicate is through the CGH web site: www.cgh.org/CGHFamily. I plan to use our web site to post a weekly letter to members of the CGH Family. This will also allow me to respond to questions asked of me or of others in senior management. I hope this web-posted letter will allow me to say directly what is on my mind and to hear directly what is on yours.

This is my first letter. Over the coming weeks, we will experiment with this format…so please give me your feedback. Send a response directly to CGHFamily@cgh.org.

As I return to Community General Hospital after several years away, I am comforted by the traditional strengths of our hospital. Over the years we have demonstrated a solid and unwavering commitment to the patients we serve, and we have paid attention to maintaining the technical skills that make us so good at care and caring.

My new role as CEO helps me see the CGH landscape in a new way. As important as they are, our traditional strengths don’t always help us when the world around us demands new ways of working efficiently or preparing for changes. So in the coming months I will be looking for ways that all of us at CGH can build on our traditional strengths to be sure, but also ways we can develop new knowledge, get exposure to new ideas, and work together in new ways.

A question I have heard more than once deals with the supposed trade-off between financial management and quality care. I was asked this question in employee meetings. Quality care can be achieved within a sound financial operation. Our Board of Directors is very interested in careful financial management and strong patient and physician satisfaction. It We have to do both things well: operate in a financially responsible way and improve patient care and service as an ongoing process. We do not honor one at the expense of the other. Both are essential.

It is in this spirit that I begin this new stage of my service to patients at Community. I look forward to hearing from you.

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This text was originally sent to the employees of Community General Hospital, Syracuse, NY, as one of a series of letters from the CEO. The text was subsequently posted on the CEO's blog, More than Medicine, started in June 2007.