Moving program off site requires planning, support from hospital leaders
Four-year effort culminates in a weekend move
Most occupational health program managers at hospital-based facilities dream about having more space, more equipment, and more autonomy, so moving off site to a freestanding clinic may seem like the solution to all of your problems. It can be, say those who have taken the big leap, but don’t underestimate how much work is involved.
The first part of the project can be the most challenging, says Judy Colby, RN, COHN-S, CCM, past president of the California State Association of Occupational Health Nurses and program director of The WorkPlace at Simi Valley (CA) Hospital and Healthcare Services. Colby recently completed a four-year effort to move her program to a location away from the hospital campus, and she says one of the hardest parts was getting approval from the hospital administration to go ahead with the idea.
She says she started thinking about moving the program off site as soon as she joined The Work-Place four years ago because she could see right away that the program was not operating to its full potential. The facility was just too cramped. The occupational health clinic was located next door to the emergency department (ED), right where it had been born, and the space had never been adequate. The clinic had two exam rooms and an office measuring 10 feet by 12 feet. With 650 patient visits per month, the clinic was always straining at the seams.
"I knew that ultimately, to really be a center of excellence and a full-service occupational health program, I would forever be making lemonade out of lemons here on the hospital campus," she says. "It wasn’t really an option to expand here on the hospital campus because I’m not the only one who was struggling for space. There are some master plans for expanding the ED and the clinic here on campus, but that still would have been a bandage and it would have taken forever to happen."
Had to get hospital execs’ support first
Moving the program off site would enable Colby’s program to provide more efficient service to clients. In the old location, there was only room for the most basic equipment, so Colby had to rely on the hospital to provide many services that she could have performed herself. Patients had to go to the hospital’s radiology department for even the simplest X-rays, and their records had to be transferred through three computer systems.
Pulmonary function testing and spirometry had to be done in the pulmonary department, which was sometimes inconvenient because the hours of operation did not match the occupational health program’s hours.
In addition, occupational health clients were often subjected to more of a "hospital" experience than necessary for simple business-related needs.
"There were times when a salesman would be in for a routine drug screen, and we’d have to walk him down the hall to a bathroom we could use," Colby says. "On that trip down the hall, he might walk by an elderly woman screaming in the hallway and a victim from a motor vehicle accident being interviewed by the highway patrol. It just wasn’t the business environment that we wanted for these clients."
The solution was clear to Colby, but her first task in moving the program off site was to get support from the hospital administration. That was not easy even though she had made it clear from the beginning that she saw that as the ultimate goal for the program. The administrators were reluctant to approve the expense of the move, partly because the occupational health program operated in the red for almost its entire life span. Why spend money on a program that’s just a loss leader to get patients into the hospital?
Colby countered that resistance by improving the program’s revenues with more emphasis on X-rays, prescriptions, and median nerve testing as a predictor for carpal tunnel syndrome. The bottom line gradually increased until the program broke even, and Colby was able to convince administrators that her program would make a profit consistently. Moving the program off site would increase the profits, she argued, and more than make up for the moving expenses. A new medical director hired for the hospital in 1999 didn’t hurt, either. He was more interested in aggressively growing the program, so Colby had an easier time convincing him of the move’s value.
Program would join physical therapy off site
The hospital’s physical therapy program had moved off site, for essentially the same reasons as Colbys. When she realized that the physical therapy program had room to spare at the new site, Colby seized on that opportunity to go ahead with her own program’s move. The hospital administration approved her idea for moving the occupational health program to the same building two blocks away from the hospital.
Several other hospital departments, such as human resources, already were in the building, so it had a strong association with the hospital but still provided the separate, businesslike setting Colby needed.
"We worked with the director of physical therapy and used input from both staffs to figure out how to utilize the space," she says. "Once we had a plan, we worked with a general contractor who had done work for the hospital before."
Once the space was built to her specifications, Colby’s new location would provide a large waiting and reception area and 11 exam rooms. Three of the rooms would be used only by the occupational health program, while the other eight were designated for the physical therapy program and available to Colby part time. Since physical therapy clients often go to the gym or elsewhere for therapy, the examination rooms are available for large portions of the day, she says.
Colby worked with a budget of $85,000 for the move. That amount had to cover nearly everything, including the construction of the new space, a used X-ray machine, and some new equipment. The hospital’s marketing department picked up the cost of reprinting all the collateral materials for the occupational health program. Various other items costing less than $500 would come out of Colby’s operating budget.
The hospital’s plant operations staff took care of physically moving the program from the hospital site to the new building. It happened during one weekend so that The WorkPlace wouldn’t have to miss a single day of operations.
"We were open for business on Friday and then open for business Monday at our new location," Colby says.
Nearly all of the program’s clients reacted favorably to the move, she says. A few clients were uncomfortable sending patients to a site not attached to the hospital, even though the new one is only two blocks away, Colby says. They got over those concerns once she explained that the program was only improving its operations, not diminishing the level of care.
"We’ve always said that if they feel comfortable putting the person in a private car or taxi to get here, were comfortable treating them. If not, they should call 911 and let the paramedics bring the person to the hospital," she says. "None of that changes with our new location."
Prior to the move, the hospital’s marketing staff visited all of the program’s major clients and presented them with a packet of new wall boards, authorization slips, maps, and other materials. They also explained the reason for the move and how the program would improve, and they encouraged questions from the clients. All other clients received the information in the mail.
Consider drawbacks before making the move
Though many occupational health programs moved off site in recent years, some experienced professionals point out that this strategy is not always the right move. Pat Stamas, RN, COHN, is president of Occupational Health and Safety Resources in Dover, NH, but in a previous position helped orchestrate a move off site for the occupational health program at HCA Portsmouth (NH) Regional Hospital. The move proved to be a good decision, but Stamas says it also illustrated some of the risks.
"One of the motivating factors in that move was to get ourselves into the employer’s community, to improve accessibility for employers and exposure," she explains. "We also wanted to compete head to head with a competing freestanding provider in the area."
Positioning your program better geographically is a good reason to move, she says. There also may be a benefit to operating from a more businesslike setting, rather than having patients go to the hospital.
The freestanding center may help rehabilitation patients feel that they are recovering, rather than still under hospital care, she says.
One of the biggest motivations may be the potential for increased revenue. But Stamas cautions that you have to balance the increased revenues with the downside of moving off site. A modest increase in revenues may not make up for the increased expenses and other drawbacks.
"Our overhead costs increased dramatically," she recalls. "The cost of electricity was phenomenal. We budgeted $2 a square foot, and it cost us $5 a square foot. You don’t have to worry about things like that in the hospital, and they make a huge difference in running your program."
Needs like electricity are no longer just provided automatically for the occupational health program by the hospital, so there’s a lot more to worry about just in terms of keeping the doors open every day. Stamas’ program shared a medical director with the emergency department before moving, but she had to hire a full-time medical director when she moved off site. That caused a huge increase in staff expenses.
Stamas compares moving off site to the difference between renting an apartment vs. buying your first house. There may be lots of reasons to do it, she says, but you’re also taking on a lot more responsibility and obligations.
"You become your own cost center when you move away," she explains. "Things get worse when the hospital [administrators] expect a higher profit margin from you after moving. Sometimes they think that you’re more of a for-profit enterprise when you’re freestanding, whereas they may have been more content with you breaking even at the hospital."
Colby agrees, though she suspects many programs would benefit from such a move if only they could get over the initial hurdles. She also cautions, however, that you must be prepared for last-minute unexpected problems.
"Planning is critical to success, but even with the best planning, things will happen that you could not have anticipated," she says. "I did not anticipate losing my key front-office person a month before the move. That was a major blow, but we just had to deal with it and keep the plan moving forward."
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