How Marin General became a case study for stand-alone hospitals

As the consolidation trend continues with hospitals, success stories about stand-alone, publicly run facilities are seemingly few and far between, save for perhaps well-known academic medical centers. While there are undoubtedly many instances of successful independents, a notable example exists in the Northern San Francisco Bay Area, in affluent Marin County – the region’s level […]

As the consolidation trend continues with hospitals, success stories about stand-alone, publicly run facilities are seemingly few and far between, save for perhaps well-known academic medical centers.

While there are undoubtedly many instances of successful independents, a notable example exists in the Northern San Francisco Bay Area, in affluent Marin County – the region’s level three trauma center, Marin General Hospital, which sits amid California heavyweights like Kaiser Permanente, Sutter Health and stiff competition across the Golden Gate Bridge.

A 235-bed district hospital overseen a publicly elected board, Marin General has been able to not just remain afloat, but also implement several innovative initiatives, including being an early adopter of using mobile devices to better coordinate with ACO patients to curb readmission rates.

Several other plans are in the works, CIO Mark Zielazinski said, including an effort  to digitize the hospital’s drug delivery pumps all from one centrally controlled office. The hospital has been able to keep pace with Meaningful Use 2 requirements that so many district hospitals struggle to meet with limited resources. And it has done so while navigating a looming $650 million rebuild of the hospital, the result of California earthquake building requirements.

But it wasn’t always such a prosperous outlook for Marin General. The story is well-known to anyone who follows healthcare in the Bay Area, but for everyone else, here’s a brief primer. In 2010, after about a decade of operating as an affiliate of Sacramento-based Sutter Health, a large and vocal contingent of local residents were thoroughly displeased with the hospital chain’s leadership.

An acrimonious battle between residents and Sutter – replete with accusations of financial mismanagement and pricey litigation – waged for years. For its part, Sutter maintained that it did nothing wrong and operated the hospital just as it operates dozens of others around Central and Northern California. Yet Sutter and its allies did warn of potentially dire consequences for Marin General if it went ahead and severed ties and returned back to public control, with major potential hurdles like the rebuild, IT infrastructure and overall competitiveness and financial health. Hundreds, if not thousands, of newspaper column inches were dedicated to the issue (including a good portion from yours truly).

It turns out the hospital’s new executive team was more than capable of handling the transition, and the bitter “divorce” between Sutter and the district is is all but a distant memory. So how did the hospital achieve stability and an impressive record of innovation amid the turbulence, both real and perceived?

In a sense, it’s Silicon Valley north.

Zielazinski joined the Marin General team about two years ago. His arrival in a way caps off the transition of an executive team that formerly headed El Camino Hospital, a 395-bed nonprofit hospital system in Mountain View and Los Gatos, both in the heart of Silicon Valley. Former El Camino CEO Lee Domanico was tapped to lead Marin General through its transition from Sutter Health. Jon Friedenburg, then vice president at El Camino, joined shortly thereafter and now serves as Marin General’s chief administration officer.

A culture of embracing technology early on came with the team, Zielazinski said, which has played a significant role in getting the hospital on solid footing amid so many other major develops, like getting voter support for a $394 million general obligation bond to support the rebuild effort and the rapidly shifting landscape for hospitals.

That same innovative spirit helped Marin General become the first hospital to use CareInSync’s mobile platform to coordinate care for patients discharged from the hospital who are at high risk for readmission. CareInSync, a Santa Clara-based mobile software developer, was later acquired by Hearst Health Network subsidiary Zynx Health.

After a pilot using what is now called ZynxCarebook, Marin General’s ACO, with nearby Meritage Medical Network, saw a decrease in patient readmissions in the ACO, from about 11 percent to about 2 percent, a reduction of 22 percent, in all-cause, 30-day readmission rates, along with a half-day reduction for average length of stay.

“It’s become an invaluable tool for us,” Zielazinski said. “This was an integral part of reducing our readmissions.” The hospital is in the process of expanding the effort, working with a number of skilled nursing facilities and care teams – including case manager, social workers, nurses and others – who all receive alerts on patients’ status.

Zielazinski also pointed to the plan of automating drug-dispensing pumps at hospital beds as another example, noting that significant efficiencies , better patient monitoring and nursing workflow within the hospital can and likely will occur when it’s implemented.

A “smart pump” can administer drugs from an IV to a patient in a far more seamless manner than having nurses individually check on and set up each one, Zielazinski said, improving on dosages, cutting potential mistakes with functional alerts when an IV is about to run out on a patient across the hospital.

“We’re trying to get better, for one, at what we waste and two, making sure that we know when the patient up on the fourth floor is going to have an empty IV bag in 30 minutes or so,” he said. “You can have a view to what’s happening more globally. And you can check the alarms on the pumps and it can be managed. Those are the kinds of things we have to get better at as hospitals.

“There’s some real efficiencies in the pharmacy but also the nursing,” he added. “Nursing doesn’t have to make sure Ivs are set up. It’s a much more real-time basis.”

Asked if the technological culture and know-how was part of the reason for success at Marin General, Zielazinski said: “That’s exactly what we want to do around here.”

With the Sutter saga long behind for both parties (Sutter still has a sizable presence in the county through its medical group and Novato Community Hospital, a much smaller facility to the north) Marin General now enjoys wide community support, which also goes a long way toward stability, Zielazinski said.

That the hospital is independent is now a boost rather than a burden, as it had been predicted, Zielazinski said.

“Because we’re an independent hospital with a very tight executive team and a very solid board, we can do some things relatively quickly, and that’s what companies who want to invest in something need,” he said.

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