Interview with Patrick A. Charmel, FACHE, President and Chief Executive Officer of Griffin Hospital.
Article Type: Interview
Subject: Chief executive officers (Interviews)
Hospitals (United States)
Hospitals (Officials and employees)
Author: O'Connor, Stephen J.
Pub Date: 05/01/2011
Publication: Name: Journal of Healthcare Management Publisher: American College of Healthcare Executives Audience: Trade Format: Magazine/Journal Subject: Business; Health care industry Copyright: COPYRIGHT 2011 American College of Healthcare Executives ISSN: 1096-9012
Issue: Date: May-June, 2011 Source Volume: 56 Source Issue: 3
Topic: Event Code: 540 Executive changes & profiles
Product: Product Code: 8060000 Hospitals NAICS Code: 622 Hospitals SIC Code: 8062 General medical & surgical hospitals; 8063 Psychiatric hospitals; 8069 Specialty hospitals exc. psychiatric
Persons: Named Person: Charmel, Patrick A.
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 271594416
Full Text: Patrick A. Charmel, FACHE, is president and CEO of Griffin Hospital and its parent, Griffin Health Services Corporation, in Derby, Connecticut. As CEO of the corporation, he is also CEO of Planetree, Inc. Planetree is a not-for-profit organization supporting an association of more than 150 US and international hospitals dedicated to patient empowerment and patient-centered care.

Griffin has been the recipient of numerous awards and recognitions, including Fortune's 100 Best Companies to Work For, the Health Leaders Media 2008 Top Leadership Team in Healthcare, the Premier Healthcare Alliance 2010 Premier Award for Quality, and HealthGrades 2009, 2010, and 2011 Distinguished Hospital for Clinical Excellence and The Health Grades Outstanding Patient Experience awards.

Mr. Charmel served on the National Advisory Council for Healthcare Research and Quality. He is a board member, and past chair, of the Connecticut Hospital Association and has received the John D. Thompson Distinguished Visiting Fellow Award from Yale University, an honorary doctorate degree and the Distinguished Alumni Award from Quinnipiac University (where he is also a university trustee), and the Deane C. Avery Award from the New London Day newspaper in recognition of commitment to the public's right to know.

Mr. Charmel is a co-editor of Putting Patients First: Best Practices in PatientCentered Care, which received ACHE's James A. Hamilton Award in 2004. He earned an undergraduate degree from Quinnipiac University and a master's degree in public health from Yale University.

Dr. O'Connor: Tell us about Griffin Hospital and Griffin Health Services Corporation and your position as president and chief executive officer.

Mr. Charmel: Griffin is a 160-bed community teaching hospital and is the largest entity within the Griffin Health Services corporate family. We are involved in some unique activities, such as our work with Planetree.

We are the only hospital in the country that houses a federally funded Prevention Research Center, and among our areas of expertise are obesity prevention, nutrition, and physical activity. Working with the top nutrition scientists in North America, we developed a comprehensive food scoring system that assists consumers in making healthy choices when buying food. The scoring system, which has been commercialized under the name NuVal[TM], is being licensed to supermarkets and disseminated to hospitals and managed care companies who do nutrition counseling and disease management. Over 90,000 foods have been scored, and these scores are influencing people's decisions, moving them to more healthy choices. In participating supermarkets, every food item on the shelf has a NuVal score next to the price and weight on the shelf tag, making it easier for consumers to figure out which food has higher nutritional value.

We pursued development of the scoring system because of our commitments to Planetree and to preventive healthcare. Planetree's foundation is in patient empowerment through access to information. Planetree tries to engage patients and to provide the information they need to make decisions about their health and well-being. This aim is part of Griffin's broader commitment to community health, health promotion, and wellness, a somewhat uncommon commitment for an acute care hospital.

Dr. O'Connor: What is it about your leadership style that has allowed the hospital to acquire so much positive recognition and national attention over the years?

Mr. Charmel: Griffin has always fancied itself an innovator, and we like to challenge the status quo. This is not a stated goal of the organization, but something that has evolved over time. We like to be entrepreneurial and look at new ways of doing things. Initially, this focus on innovation came from a need to differentiate Griffin in the marketplace. Twenty years ago the hospital was not differentiated. It had a poor reputation and suffered a long period of decline. If allowed to continue along that trajectory, the hospital would not have survived. We went through a process in which we engaged the community and sought their input. We did not get a lot of specifics, so we began to talk to employees as a proxy for the community. We talked to some of the approximately 1,000 employees who live in the surrounding area, asking them what an ideal hospital experience would look like for them and their families. Once we understood, we contrasted ourselves with the stated ideal. There was a gap between what we said we wanted to be and what we acknowledged we were; it created a lot of dynamic tension in the organization. It was the first time we were really honest with ourselves. We made a firm commitment to our staff and our community that we would get to that ideal state. A strong sense of ownership on the part of everyone associated with the organization has been instrumental in getting to that ideal. The staff and community felt proud when we began to make strides and show improvement. Our efforts led us to being considered a great place to work. We are visited all the time by companies inside and outside of healthcare who ask about our strategic plan for becoming an employer of choice. We tell them that we never had one. We never set out to be an employer of choice, but we did set out to be a great place to provide an exceptional patient experience, to deliver great care, and to be a great place for caregivers. We realized that we could never be a great place to be cared for unless we really took care of our caregivers and engaged them in the process of organizational transformation.

Dr. O'Connor: Employee pride appears to be an essential ingredient for Griffin.

Mr. Charmel: A few years back when we were ranked fourth in the country on the Fortune 100 Best Companies to Work For list, we had the highest pride rating of any one of the Best Places to Work companies. We came to realize that pride is absolutely fundamental. It is not about employee satisfaction, but employee pride. How do you create that sense of pride in the organization? By having credible management, delivering on promises, walking the talk, setting high standards and meeting them, and being sure to reward and recognize employees in the process. Initially, Griffin set out to create programs and services that were responsive to consumers, by emphasizing customer service and by creating a great service experience. The discipline we developed has served to improve clinical performance as well. We went from being a laggard in service and clinical quality to being a leader in our state, in terms of objective measures of quality, and one of the leaders in the country. Again, this has resulted in a strong sense of employee pride, which facilitates continued improvement. Griffin is a small hospital that became an influential leader, and we try to remain an organization that others seek to emulate. We have helped many organizations, directly and through Planetree, and we are committed to continuing to help others.

Dr. O'Connor: What is Planetree and why has Griffin Hospital been so deeply involved in following its tenets and approaches ?

Mr. Charmel: When Griffin was struggling we engaged our employees in the community to define an ideal hospital. Initially, we experimented, focusing on one service at a time, beginning with our then-failing maternity service. We turned it around by talking to women of childbearing age and to women who'd had babies here and elsewhere, and by creating a new patient-centered model of maternity care, which became the first hospital-based birthing center in New England. We went from a service in decline to one that was rapidly growing with very high patient satisfaction. It was a good first step, but the hospital's overall reputation did not improve. We were not so presumptuous to think that because we improved one service line we could apply that same approach hospitalwide. We needed to find other models of patient-centered care.

That led us to Planetree, which at the time was a single, 13-bed unit in the 500-bed Pacific Presbyterian Medical Center that is now California Pacific Medical Center. That model Planetree unit came about through the initiative of a patient, Angie Thieriot. As Angle battled a rare viral infection, she was disheartened by the lack of personalized care at the hospital. Her response was to start Planetree, which began as a consumer health library in downtown San Francisco. Angie believed that hospitals could become more responsive to consumers by empowering them through access to information so they could be actively involved in decisions affecting their care and well-being. This was pre-Internet late 1970s. Back then healthcare consumers, at least when they were hospitalized, certainly were not engaged. "Ideal" patients were compliant and passive and let providers do things without questioning them or complaining. That "ideal" did not serve patients' interests.

Thieriot and her team started a consumer health library and created a groundswell of informed consumers. The hospital where she had the bad experience invited her to work with them to create a prototype unit. The unit revolutionized the physical environment of inpatient care delivery by involving family members and removing typical barriers and restrictions between caregivers and patients. Griffin discovered Planetree when it was in its infancy. Planetree had several model units, mostly on the West Coast, with one in New York City. We discussed a relationship but did not want to be a model unit--the model unit approach was very prescriptive. We sought a looser relationship so that we could experiment. Griffin was the first affiliate of Planetree, and really the first hospital in the country, to build a completely new facility from the ground up based on Planetree's patient-centered care principles. We had the freedom to design a hospital around these principles, and we won many industry design awards. The hospital's image and reputation improved dramatically. There was a lot of industry attention and recognition, which we deflected to Planetree in California, and that attention was a challenge for them. They were a small, socially minded organization trying to change the world but did not have a strong infrastructure to field those inquiries and help organizations who wanted assistance. In 1998, after Planetree began to show signs of stress, we offered them the opportunity to become part of our corporate family. They were an independent, not-for-profit organization and were not based within a provider organization, so becoming part of the Griffin organization provided a great showplace for people interested to learn about the model. People could see Planetree in practice, kick the tires, and talk to caregivers, and we could keep Planetree's operating costs down because of our shared resources and infrastructure. Planetree came to Connecticut and has since grown dramatically, to 150 organizations with about 500 care sites across the United States and a number of foreign countries. Our work with Planetree maintains our commitment to the model that led to our success as a hospital and allows us to spread the philosophy to others as well. The work has been very rewarding. Within the last six months, the Veterans Health Administration has contracted with Planetree to facilitate the implementation of patient-centered care across the VA healthcare system.

Although I'm the CEO of the hospital and its subsidiaries, Susan Frampton, PhD, the president of Planetree, has led its expansion and is responsible for Planetree's tremendous success. She is a very skilled and passionate executive. Planetree is the leader of the patient-centered movement in this country. Planetree shares its best practices through patient-centered care improvement guides available free of charge online at the Picker Institute and the Planetree websites. These guides allow those who don't want to become Planetree alliance members to access the best practices of the world's premier patient-centered hospitals. Organizations are realizing that they need to become more patient focused to meet the expectations of more demanding consumers (especially those paying more out of pocket) and to succeed and thrive in the coming era of pay for performance and value-based purchasing.

Dr. O'Connor: Your approach to leadership has been distinguished by frequent, open, and honest communication with employees. What role has communication played in developing credibility, trust, and enhanced relationships with your employees ?

Mr. Charmel: Because our organization struggled early on, we felt the only way we could survive and be successful was to engage our staff in meaningful ways. My leadership style is honest and very open to sharing information. We are strong proponents of transparency--it's what we believe in, and it prompts us to perform at a higher level. Being open and transparent about our performance puts pressure on the organization to continually improve. Employees know that transparency, openness, and engagement is the expectation. We have a strong culture and philosophy that keeps us in line as leaders. If we are not being true to our values, employees will tell us, which can be challenging at times. A common phrase here is "That is not Planetree." When we hear that, it may be because we did not explain things clearly and the employee misunderstood, or it may be because the employee is right and we compromised when we should not have.

Dr. O'Connor: Tell us about the role of leadership communication during the anthrax inhalation death at Griffin in 2001.

Mr. Charmel: That was a pretty remarkable experience. The patient presented to the emergency department and was found to have inhalation anthrax. This occurred during the national anthrax scare, but there had been no anthrax in our area. The state health department did not believe the test results. They were very skeptical, and we had to convince them to be persistent because we thought we were right. When it became apparent that the patient did have anthrax, there was a strong effort to restrict information flow. This restriction was inconsistent with our culture and it caused tensions between us and various authorities, including the FBI. When the information was still fresh, the FBI did not want me to share it with staff. By that time, staff were aware of the possibility of an anthrax case. I was concerned for their safety, the safety of our community, and our families. While still protecting the patient's privacy, we told employees what we had found, what we were going to do about it, and what the risks were. We wanted to talk to the community, too. When law enforcement told us not to, I said, "You can't stop me." I only realized later that they were carrying guns and certainly could have stopped me. But we did share the information, and I think we did the right thing. We understood that there were some law enforcement benefits of not sharing the information, but they were exaggerated. Disclosing the information reinforced our culture during a very stressful time. Our patient-centered principles guided us. Unfortunately, the patient died. The patient's death was unavoidable. The experience cemented for us that even in the face of strong opposition and adversity, we tried to do the right thing.

Dr. O'Connor: The career of a healthcare executive often involves numerous moves for developmentally progressive career opportunities in different geographic locations and different organizations. However, you have spent your entire career, from undergraduate intern to president/CEO, at Griffin Hospital and have stated that "Often it is better to bloom where you are planted rather than seek a bigger pot." Please expand on and illustrate what you mean by this statement.

Mr. Charmel: I was told repeatedly by recruiters, my colleagues, and my professors that I was limiting my career opportunities by staying at Griffin. Frankly, they have stopped telling me that, but they tried for a long time. The conventional wisdom is that you start at a small hospital, develop a good track record, then use that as an opportunity to step up to a larger, more complex, prestigious organization with greater compensation. I am a firm believer in continuity of senior leadership. High-performing organizations are usually characterized by stable, credible, competent leadership. I feel some obligation to this organization because I have asked the staff and board to make many sacrifices and commit to excellence. They have met every challenge and fulfilled every commitment. Griffin has given me tremendous opportunities. I don't know too many organizations, large or small, that have had the kind of impact this organization has had. The career development advice I suggest is to not necessarily buy the conventional wisdom. I've spoken to a lot of people who have gotten to where they want to be career-wise but have jumped around a lot and don't have the same sense of fulfillment or accomplishment I have. They have sacrificed in the process. I don't think moving between organizations is necessary, and there are other examples like me. Employees in organizations that have a lot of senior management turnover spend too much time figuring out who has the power, how things are going to change, and either keeping their heads down or figuring out who they're going to align with. We haven't seen a lot of that here.
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