Sun photographer Steve E. Miller and I are standing in a labor and delivery suite at Lompoc Valley Medical Center. And, in this case, the term “suite” really does apply. It’s a large space—about the size of a living room—with polished wood paneling and ambient mood lighting. Hanging on the walls are pastoral paintings of hillsides and mother sheep with their newborn lambs.
Naishadh Buch, the hospital’s chief operations officer, slides one of the paintings up to reveal a hidden compartment for the various medical gases used during delivery. Hiding the equipment with wall art, Buch says, helps create a more welcoming atmosphere for women and their families.
He’s in the middle of explaining how the side couch converts into a bed for exhausted fathers, when classical music starts streaming out of the room’s overhead speakers.
The melody is familiar and soothing; the music of choice for countless Hallmark cards and automated baby toys.
“That’s ‘Brahms’ Lullaby,’” Buch says, his lips spreading into a large grin. “We play it every time a baby is born. It plays throughout the entire hospital.”
Outside in the hallway, we see that there’s a big, yellow “Brahms’ Lullaby” button on the wall for nurses and doctors to push when a baby is born.
Buch says the staff members like to use the birth alert system as a happy reminder for other patients, who are usually sick or in pain.
“That’s one of the few positives that happen here,” he says, explaining that boosting patients’ spirits is an important part of providing quality health care.
Time for a facelift
Improving patients’ perceptions of the care they receive has been a major goal of the hospital’s staff members since relocating last year from a 65-year-old building on Hickory Street to a brand-new facility on East Ocean Avenue.
“The problem with the old place was that it was old. You could have the best staffing in the world, but you can’t overcome backed-up plumbing,” Buch said. “I think the quality of the care was always there; it’s just that the perception wasn’t always there.”
Well, now it is.
Based on a patient survey conducted by NRC Picker, a national health-care research corporation, Lompoc Valley Medical Center is one of the most improved hospitals in the corporation’s national membership group. The results are based on responses from adult inpatients surveyed between April 2010 and March 2011 compared to responses from April 2009 to March 2010.
“Generally, when a hospital moves [the approval rating] bumps up about two or three points,” Buch said, “but this year’s survey results showed a 20 percent sustained bump.”
Buch credited the improved rating to two things: the new facility and the staff.
Not only is the hospital larger and safer, all of the equipment inside its walls is state-of-the-art.
“We didn’t bring over any equipment from the old hospital. Everything is new,” he said. “We got all new, state-of-the-art stuff because that’s what the people deserve.”
Buch views the nonprofit hospital as the people’s hospital, paid for by taxpayer dollars. (Health care district voters approved a $75 million bond measure to pay for construction of the new hospital in 2005.) But that money, he explained, only pays for the building itself. Everything else comes through donations and fundraising.
“If you take the building and turn it upside down and shake it, everything that falls out has been paid for in other ways,” he explained, adding that the hospital’s foundation has raised approximately $4 million to date.
The new facility and equipment enable hospital leadership and staff to provide the best care they can possibly give.
“It allows us to focus on things that we didn’t have as much time for at the old hospital,” he said.
Instead of worrying about bad plumbing or unreliable machines, nurses and doctors can devote all their time to patient care and training the next generation of health-care professionals.
No rest for the healer
There’s no doubt that hospital staffers are proud of their award. The triangular, glass trophy sits on full display in the middle of the nurses’ station in the med-surg unit, the largest wing of the hospital.
Buch said he chose to put the award there—instead of in the lobby or another area with high foot traffic—to remind staffers of their successes and, at the same time, to motivate them to do even better.
“If you take care of the patient, everything else—the scores and maybe even awards—will fall into place,” he said. “If you spend all your time worrying about stupid things like scores, then the focus is wrong. It’s about doing the right thing for the patient.”
Doing the right thing for the patient sounds simple enough, but that’s not always the case, especially considering changes to the health-care field and an influx of more patients spurred by the Affordable Care Act of 2010.
The biggest challenge for the hospital, CEO Jim Raggio said, will be “keeping [health care] delivery standards high.”
“We’re going through a transitional period in health care. The whole landscape is changing—regulations, reimbursement structures, state mandates—everything,” he explained.
And don’t forget money.
“The federal and state budgets are in crisis,” Raggio said. “You’ll be told you have to do something [to meet government standards]—but we’re not going to pay you for it.”
Government officials, he said, find it’s much easier to “reduce payment to doctors in hospitals than it is to reform the whole delivery system.”
Add to those challenges a contradictory mix of hiring freezes and projected health-care-worker shortages, and it can all get a little overwhelming, to say the least.
Numerous research foundations across the country, including the California Health Care Foundation, are expecting a significant shortage in primary care physicians by 2015.
This projected shortage can be attributed to a variety of factors. Approximately 30 percent of the state’s doctors are older than 60, many of whom have been postponing their retirement since the economy faltered in 2008. Additionally, more and more doctors in California are choosing to become specialists, who tend to make more money.
Currently, Lompoc Valley Medical Center has several dozen physicians using its medical facilities. According to state law, hospitals can’t directly hire physicians. Instead, physicians in the community go through a credentialing process to perform surgery and other medical practices at the hospital. It’s uncertain how many such doctors are planning to retire soon.
For many doctors, traveling back and forth between the hospital and their individual offices can be difficult, so Lompoc Valley Medical Center offers a hospitalist program, through which hospital-based physicians and other medical professionals oversee in- and out-patient care.
“These people never leave the hospital. Their specialty is caring for people in the hospital,” chief operations officer Buch said.
Buch said he and his staff also have a proactive system for challenges faced by the nursing profession.
According to a 2009-2010 survey from the California Institute for Nursing and Healthcare (the latest data available), the unexpected difficulty of new Registered Nurses finding employment is now California’s most pressing workforce issue. Approximately 43 percent of the new RN graduates surveyed said they still hadn’t found work six months to a year or more after graduating.
Yvette Cope, a registered nurse and director of the Lompoc Valley Medical Center’s critical care and med/surg units, said a lot of hospitals don’t hire nurses straight out of school because they’re generally inexperienced and expensive to train.
“At a small hospital like this, you have to know everything from head to toe,” Cope explained.
Several years ago, when the American nursing shortage was at its peak, hospital officials brought in several groups of nurses from the Philippines and India, both countries with surpluses of health-care professionals.
But now, thanks to improvements to the state’s nursing education programs, hospital officials hire locally more often. Cope said since becoming unit director a year ago, she’s hired seven or eight new grads, most of whom came from the Central Coast.
“It’s good for the economics of Lompoc and it’s good for Allan Hancock College,” she said, adding that she and other hospital officials have created a multi-pronged system that allows them to hire new nurses without sacrificing experience.
New grads get their basic training at med/surg under the tutelage of longtime nurses and doctors, and then they eventually move on to more specialized units.
To bring in more experienced staffers, the hospital contracts with traveling nurses for several months and brings in nurses from other local hospitals to do per diem work one day a week.
“We started with about 11 travelers when I first got here, and now we’re going to have about two or three next year,” Cope said. “Nothing against travelers, of course, we have some fantastic travelers—it just doesn’t promote a unified atmosphere because they’re not as invested.”
But sometimes the hospital and surrounding community do entice travelers to stay. Cope said one nurse met her husband while working at the hospital and decided move to Lompoc. Another nurse liked the area and the hospital so much she relocated from another state.
Laurie Fisher, a traveling nurse from Arizona with 20-plus years experience, said she’s heard lots of nurses say, “‘Boy, I’ve learned more [at Lompoc Valley Medical Center] than I’ve learned anywhere else.’”
And she’s one of them.
“At a small hospital, the nurses have to know how to do everything. You see more and you get to do more,” Fisher said, adding that she’s been able to do procedures at Lompoc she’s never done before.
“Have you ever heard of Ketamine? On the streets it’s called Special K, but it’s actually used for conscious sedation, especially with children, and it’s very, very tricky,” she said. “We just used it a couple weeks ago, and everything went really well. I’ve been a nurse for 20 years and never been able to do that.”
Fisher said she also likes the small-town atmosphere in the hospital and the rest of the community.
“I’ve worked for some very high-end places where it’s very dog-eat-dog. I’ve actually left jobs because I wasn’t going to play that game,” she said. “I’ve found no one like that at Lompoc. It’s very community oriented and family oriented.”
So, could Fisher’s traveling days soon be over?
“She’s one of [the travelers] I’m working on,” Cope said.
Fisher is more coy with her answer.
“I love this area of California, it’s just gorgeous. And it’s such a beautiful little hospital,” she said, but then confided she might have a few more adventures lined up before she “figures the whole California thing out.”
Contact Managing Editor Amy Asman at aasman@santamariasun.com.
This article appears in Dec 1-8, 2011.