To cut costs and streamline its operations, Howard County General Hospital is increasing employees' workloads and reorganizing departments.
By trying to deliver care more efficiently, the hospital hopes to avoid layoffs among its 1,300 employees and to increase productivity by 20 percent during the next two to three years.
The cost-cutting measures come at a time when the hospital expects a $2.6 million surplus for fiscal year 1995 but still faces increasing financial pressures.
"It is not a question of cutting money from the budget," hospital President Vic Broccolino said yesterday, "but improving productivity . . . or reducing expenses. We're trying to do a combination of the two."
But union representatives said they can't imagine doing more work -- when, for example, many registered nurses already stay after work to complete medical charts without benefit of overtime.
"The charting is more than ever, and the staffing is lower than ever," said Jean McCartney, a labor and delivery nurse and representative of United Food & Commercial Workers, Local 27. fTC "It's frustrating."
Howard County General Hospital is one of a growing number of hospitals across the country attempting to reorganize its operations. Johns Hopkins Hospital in Baltimore recently announced plans to reduce costs.
"There's a growing list of hospitals having a consultant coming in to re-engineer," said Nancy Fiedler, senior vice president of the Maryland Hospital Association. "It's become a term I've been hearing more and more often."
Competition from less expensive hospitals and outpatient medical centers, falling occupancy rates and shorter hospital stays because of insurance requirements are forcing hospitals to reorganize.
"Insurers, HMOs, employers and insurance companies are looking more and more at price and convenience," Mr. Broccolino said. "It's the need to be competitive in a marketplace that is changing at light speed."
Under the local hospital's re-engineering plan, related departments will merge, and employees will be retrained to do other jobs and reassigned to other departments.
Critical care nurses, for example, could be trained to work in the emergency room. Instead of reporting to various managers, all senior vice presidents will report to the hospital's chief operating officer, Steve Cohen. Some vice presidents and other officers will have additional duties.
Hospital administrators also may reduce personnel costs through attrition and hiring freezes. "We can't force anybody to do a different job," Mr. Broccolino said. "But the more flexible a person is, the more valuable they will be to us."
But some employees fear retraining highly specialized nurses for other jobs will endanger patients. "We're so highly specialized and high tech, it's impossible to be adept" in several fields, said Carole Gardiner, a certified registered nurse anesthetist who serves as a union representative for Local 27.
Another union representative, Margaret Mazcko, a medical and surgical charge nurse, said nurses are overworked already and can't take on more responsibilities without the help of nursing assistants, who do routine tasks such as dressing wounds.
"Nurses are concerned about patients not getting proper care," Ms. Mazcko said. "The nurses are not angry about [reorganization], they're angry about leaving [work] without giving good care. . . . We are looking forward to reorganization. We're looking forward to it being a help."
During Ms. Mazcko's shift, four nurses handle 36 acute patients with help from three nursing assistants. "We can't do anymore," she said.
By February, the hospital plans to hire a consulting firm that will analyze everything from patient care to purchasing procedures.
Patients already have seen some changes. In September, the hospital consolidated three rehabilitation programs -- occupational therapy, physical therapy, and speech and language pathology -- into one unit.
The hospital also is trying to streamline services by building a three-story ambulatory services building, where all outpatient visits will take place, beginning in 1996. Right now, those services are scattered throughout the hospital.
Increased competition and changes in the requirements of health insurers have forced the hospital to alter its operations, Mr. Broccolino said.
Health insurance companies are demanding lower prices for medical care and directing consumers to less-expensive hospitals and to outpatient service facilities such as surgical centers, diagnostic-imaging centers and testing labs.
"As more and more of health care is going from inpatient to outpatient, we need to be able to compete against all those people," Mr. Broccolino said.
The hospital has restructured its health insurance and retirement benefits, enabling it to save $3 million during the next three years, Mr. Broccolino said. The hospital's operating budget for fiscal year 1995 is $76 million.
Reorganizing the hospital's operations is imperative to its survival, he said. "If we don't re-engineer and don't stay competitive, our hospital could be taken over by a company with greater resources than ours," he said.
This spring, the hospital was approached by a health care company that wanted to merge operations, Mr. Broccolino said. A 32-member board of trustees runs the not-for-profit hospital.
"We haven't had any substantial discussions or negotiations," he said. "I don't believe we're ready for anything like that."
Falling occupancy rates and shorter hospital stays also are driving reorganization efforts. During the past eight years, occupancy rates at the hospital dropped 40 percent, Mr. Broccolino said.
Of the 223 beds the hospital is licensed to operate, 170 to 180 are in use at any given time.