November / December 2005
King Drew Medical Center: Eye of the Storm
Hurricane Katrina taught government and society many lessons. Among others, it laid bare our American healthcare system’s failures. The task of reconstructing a sensible healthcare system for the United States is urgent. It has been nearly a dozen years since the last attempt to reform healthcare, and the system is more broken than ever.
Just as the destruction from Hurricane Katrina was being fixed, Hurricane Rita posed a second threat to the Gulf Coast, and now a third hurricane, one that may hit the Los Angeles area, is being watched.
This third hurricane, the healthcare hurricane, may prove just as deadly and destructive as the other two. The eye of this hurricane is headed for South Los Angeles, one of the poorest areas in California, which is populated mainly by Latinos and Blacks. The storm is forecasted to hit the area in early 2006, and its damage will come from the loss of comprehensive hospital services resulting from the downsizing of the King Drew Medical Center (KDMC).
In February 2005, the KDMC Trauma Center was closed. This was followed by a recommendation on August 5 to the county Board of Supervisors to close obstetrics, pediatrics, and neonatology. Issues of patient safety and medical errors have led to loss of JCAHO accreditation and closure of 3 of KDMC’s 18 post-graduate residency training programs.
In March 2005, the Los Angeles County Board of Supervisors appointed the KDMC Hospital Advisory Board (HAB). It is comprised of 15 healthcare experts, most of whom have national reputations for excellence in academics, teaching, healthcare quality, management, and policy (Flores, 2005).
This expertise is focused on ensuring the future of KDMC and preserving the important hospital and ambulatory clinical services specifically provided to the residents of South Los Angeles. Loss of significant hospital services at the medical center will impact all residents of Los Angeles County.
The future of any hospital is complex. Management strategists have labeled this unpredictability the “fog of the future.” This fog is created by a mix of “golden opportunities” and “sudden death threats” (Sull, 2005). The hospital industry is volatile, with many variables, the interactions of which create unexpected outcomes. This uncertainty was captured recently in a comment made by Supervisor Molina regarding concerns over the approval of $32 million to repair deteriorating facilities at KDMC. She stated, “Every single time we put a fix into this, we think it’s a fix. And then if we go down the line, we find out it’s not really a fix” (Leonard, 2005).
These repairs are the first part of a two-phase refurbishment plan that is estimated to cost $64 million. What clinical services can KDMC provide while operating in this foggy future?
The county’s attempts to revitalize KDMC by a process of elimination rather than by restoration has puzzled community advocates and local, federal, and state officials. What evidenced-based criteria exist that support such a redesign plan? What national experts have endorsed this process as safe, with minimal risk to the health of the community?
An active and viable community voice, called The Coalition for Health and Justice, has emerged in an extremely short timeframe. This coalition, representing a pan-ethnic profile of community-based health advocacy and policy organizations, has developed guiding principles under a project called A Campaign to Transform King Drew (2005):
- Reforming and fixing KDMC must focus on providing comprehensive quality healthcare services to South Los Angeles.
- Any effort that reduces the scope of services and jeopardizes the hospital’s ability to address the critical healthcare needs of South Los Angeles is not acceptable.
- KDMC must continue to function as a teaching hospital.
These principles are contrary to the current direction of the recommendations put forth by the director of health services. An additional powerful voice opposing the director’s recommendations became evident in an August 10, 2005, letter from the HAB to the Los Angeles County Board of Supervisors. In this letter, the HAB raised concerns over the process and reporting relationship of the HAB to the Board and concluded that the recommendations for service reduction threaten “the stability of the institution at a critical time” and “the long-term impact of any reduction in services on the community of South Los Angeles has not been adequately studied” (Flores, Lott, & Bolton, 2005).
Sometimes volatile markets generate new resources such as technical innovations, privatized assets, or new knowledge. These new resources in the KDMC crisis are being realized. Preliminary discussions with private hospital systems are taking place at the direction of the Board of Supervisors to evaluate the possibility of privatizing the medical center. A new knowledge source titled, Sick System: A 10-year Look at the Los Angeles Health Care System and Its Current State of Healthwas released in August 2005 by L.A. Health Action (Tranquada, Vera, Gupta, & Quinn, 2005). This policy brief further documents the severe health needs of South Los Angeles and makes the following recommendations:
- Stabilize funding for the Los Angeles County healthcare system.
- Continue health system improvements achieved during its previous 1115 wavier (a 1115 Wavier is issued by CMS to state departments of health to allow special changes in the use of the federal portion of Medicaid dollars that a state receives).
- Eliminate racial and ethnic disparities in healthcare and health status.
- Examine alternative management systems for Los Angeles County Department of Health Services.
- Create a comprehensive, coordinated system of care for Los Angeles County residents.
The response and management issues that resulted from Hurricane Katrina may have an effect on the KDMC crisis. This national disaster revealed the vulnerability of poor people, their disadvantages in reacting to a natural weather crisis, and the lack of government preparation for and responses to the damages caused by the hurricane.
The loss of comprehensive hospital services at KDMC poses a real threat to the public health of all people in Los Angeles County. The cumulative effect of eliminating trauma care, pediatrics, obstetrics, and neonatology will likely increase hospital bed shortages, overload area emergency rooms, and decrease availability of primary and specialty care services. This will worsen the mortality and morbidity by increasing the foggy future of healthcare for all county residents.
Significant healthcare value disproportionate to the resources invested can be created by searching for the uncommon common goals between the Board of Supervisors and key stakeholders. The success of this opportunity lies in coordinating and integrating action in an effective and efficient manner.
What is the fix? Simply put, make KDMC the “Toyota of Healthcare.” That means fixing this minority academic medical center from the inside and applying the same operation techniques that drive the famous Toyota Production System (TPS). Some organizational management experts are said to be exaggerating when they predict that the TPS can save tens of thousands of lives and billions upon billions of dollars in healthcare costs. Pilot studies have produced result where death from central line infections has fallen 87% (Spear, 2005). Others report improvements in dispensing operations, patient falls, and ventilator-acquired pneumonias. Hospitals have achieved these results by applying the philosophy, principles, and tools of continuous organizational self-improvement and experimentation developed by Toyota. The evidence is clear: dedicated people who work in hospitals can make improvements in these institutions.
America is struggling under the effects of these hurricanes and the healthcare burden they have created. It is time to fix KDMC and our healthcare system in general from the inside.
Robert A. Beltran (firstname.lastname@example.org) is chair of the legislative committee of the California Latino Medical Association (CaLMA), president of the Latino Med Policy Institute, and editor-in-chief of LatinoMed Journal. He graduated from Keck School of Medicine at the University of Southern California, was a surgical resident at LAC-USC Medical Center, and a private-practice general surgeon for 20 years. Beltran holds an MBA in healthcare from UC Irvine, School of Graduate Management. In addition to healthcare practice, he has extensive experience in organizational development and management especiallyÝas itÝrelates to diverse and underserved communities. His expertise includes public as well as private healthcare organizations, medical groups, health plans, professional associations, county healthcare systems, and hospital systems.
The Campaign to Save King Drew, www.transformkingdrew.com
Flores, H. (2005, May 24). Report to CaLMA Board of Directors regarding King Drew Medical Center and Drew — UCLA.
Flores, H., Lott, J., Bolton, L., (2005). Action by the HAB at its August 10, 2005 Special Meeting, p. 1-3.
Leonard, J. (2055, September 7). $32 Million Is Okd for repairs at King Drew, Los Angeles Times.
Major Cuts at Hospital Urged. (2005, August 5) Los Angeles Times.
Spear, S. J. (2005, September). Fixing health care from the inside, Harvard Business Review,78-91.
Sull, D. N. (2005, September). Strategy is active waiting. Harvard Business Review,121- 129.
Tranquada, R., Vera, Y., Gupta, N., Quinn, H. (2005, August). Sick system: A 10-year look at Los Angeles health care system and its current state of health. L.A. Health Action, Policy Brief.