St. Joseph In Transition

August 15, 1994|By Patricia Meisol | Patricia Meisol,Sun Staff Writer

A key to the culture of St. Joseph Hospital in Towson can be easily gleaned from a bronzed list of its leaders posted in a hallway. Their names all begin: "Sister M . . . ."

But like a lot of things in health care, the tradition of the Sisters of St. Francis of Philadelphia has given way to practicalities.

For the first time in the hospital's 130-year history, a "Mr." is in the executive suites. Mr. John S. Prout, to be exact, is the first lay person to run the hospital since it opened in a house on Caroline Street amid a smallpox epidemic in 1864.

Mr. Prout takes over at a time when one of the things St. Joseph prides itself on, patient care, is being redesigned in the wake of growing price pressures at hospitals across the country.

His challenge, he said in an interview last week , is to emerge from the current turbulence with his hospital's loyal following of patients, its strong relations with doctors, and its good reputation for nursing care intact.

The hospital has a low-key image. Its prices are below average and the breadth of its sophisticated medical offerings unusual. In 1993, it was one of the five busiest surgery centers -- inpatient and outpatient -- in the state.

Mr. Prout, 45, who became president and chief executive July 1, succeeded Sr. Marie Cecilia Irwin, who retires this fall after 40 years as a hospital executive, including 20 at St. Joseph. Trained as a nurse, she focused on improving patient care.

Precisely because he is the first lay leader, Mr. Prout said he expects to spend more time and effort integrating the hospital's mission and values into daily activities. With a nun in charge, everybody knows what the place stands for, he said.

Now, "with all the changes, we need to articulate it more clearly, because those are the things that set us apart," he said.

(Although Mr. Prout is the first chief executive from the outside, he also could be the last -- there are sisters being groomed for CEO positions at St. Joseph and 11 other hospitals in the Franciscan Health System all the time, the system's office in Philadelphia says.)

Mr. Prout joined St. Joseph as chief operating officer in February 1993, and moved to Baltimore from the Midwest, where he has been a hospital executive since earning a master's degree in hospital administration from Washington University in 1974. Before joining St. Joseph, he was second-in-command of a 406-bed Catholic-sponsored hospital in a Chicago suburb. But nothing in his 20 years in the business prepared him for the environment now unfolding in health care, he said.

Hospitals used to provide "this much care," he said, stretching his arms out about a foot wide. Now they provide "only this much," he said, shrinking them back about six inches. As a result, hospitals are now attempting to get involved with the patient before and after the hospital visit.

The questions being asked by medical researchers and the public are different, too. The debate over when to begin rehabilitation for a hip replacement used to focus on one or two days after surgery. Now studies are showing patients can recover sooner if they start exercising three weeks before surgery.

Mr. Prout is taking a hands-on approach to the redesign of patient care, which he says is being undertaken from the patient's point of view rather than from what's best for the hospital. Now the hospital is asking what role it should play in a person's health -- not just illness -- and how it can work with other partners to do it most efficiently.

The hospital has hired the accounting firm of Deloitte & Touche to help it restructure and expects to reduce the ranks of middle management and nursing staff, as other hospitals have, in the next 18 months.

Above average in size, with 460 beds, St. Joseph is also unusual in the amount and sophistication of specialty medical care for a community hospital. Mr. Prout calls it a hybrid.

The hospital is one of a select group in Maryland that are managing to attract more patients from a shrinking pie. It also is among the most profitable. St. Joseph earned $7.4 million on revenues of $131.6 million in 1993.

The hospital's growth is the result of historic specialties and doctor loyalties. Its doctors, patients and board members often have long family ties to the hospital.

"Its personae in the marketplace was that of a hospital with a very caring attitude toward patients," said William E. Hooper, a marketing consultant, chairman of the hospital board and former president of W. B. Doner & Co., the advertising firm.

"The presence of the nuns and the whole attitude of the staff affected the culture of the hospital," he said. But it wasn't until he joined the board, said Mr. Hooper, whose father-in-law was once chief of obstetrics at St. Joseph, that he realized the hospital offered "not just good quality medicine but also, the high end of technology."

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