When John Bluford came to Truman Medical Center 15 years ago, its new CEO inherited a hospital system in turmoil.
Bluford’s predecessor had managed to alienate the medical staff on Hospital Hill and at Truman’s sister Lakewood hospital in eastern Jackson County. Deep cuts to Missouri’s Medicaid program were threatening an important source of the safety-net hospitals’ revenues.
But Bluford had a reputation as a turnaround artist. As administrator of Hennepin County Medical Center in Minneapolis, Bluford converted a perennial money-loser into a regular moneymaker. He oversaw millions of dollars in upgrades to the hospital's facilities and reduced its dependence on county subsidies.
At Truman, Bluford worked quickly to mend relations with faculty members at the University of Missouri-Kansas City School of Medicine, who serve as the hospitals’ medical staff. He upgraded technology; Truman was the first area hospital to digitize its X-rays and other radiology imaging. And he began a series of projects to modernize the drab institutional facilities on Hospital Hill to make the hospital more inviting to patients with private insurance.
Truman’s burnished reputation may have helped last year when a city health levy to fund Truman and five safety-net clinics was up for renewal. Voters gave it their overwhelming support. Even voters north of the Missouri River, who had opposed the levy previously, came out in its favor.
Early this year, Bluford, who recently turned 65, announced he would retire on July 18.
Charles W. Shields, currently the chief operating officer of Truman’s Lakewood campus, succeeds Bluford as president and CEO of the Truman Medical Centers system.
Last month Bluford sat down to discuss his years at Truman and the hospital system’s future. His comments have been edited for length.
Q: How would you assess the situation at Truman when you first arrived?
A: Basically a state of disarray. If nothing else, we have made a meaningful change in the culture of our institution, that is, how the institution perceives itself and how it functions.
I saw a quote the other day that resonates. “Your culture is your brand.” If that’s the case, we’ve done well because our brand has a nice shine to it today, and perhaps it did not then. One of the attractions of the job was this community wanted to see a better mousetrap. They wanted to see a stronger institution.
Q: How did that show itself?
A. I can’t think of any time when I made phone calls to civic, to faith-based, business or political leaders and was not received in a positive way, and more times than not received the support or advocacy that I was soliciting. And that was always forthcoming because ... we made a strong case that this institution is a valuable community asset.
People think about the 75,000 people who needed to use an emergency room, the 3,500 people who needed to deliver babies. They needed Truman Medical Center, and so do a lot of businesses in the metropolitan area.
Truman generates hundreds of millions of dollars in economic benefit to Kansas City. We have gone from being a $200 million operation and now we’re close to a half-billion-dollar operation. We’re a major builder, a major purchaser of supplies, commodities.
We made that case, we can buy a lot more supplies and commodities with $450 million than we could with $200 million. And that started to give a whole different view of who we are and what we mean to the city.
Another fundamental change is the journey from quote-unquote “just being a safety net” to being a “quality net.” And the transition between those two labels represents a competitiveness that we have earned in the marketplace to be a strong health care provider for anybody.
Q: A hospital not just for poor folk.
A: For vulnerable patient populations, but for anybody who is sick.
Q: One of the things you did was improve the hospital’s physical plant.
A: It’s almost unbelievable. We have invested over $500 million in capital improvement over these last 15 years. Part of the strategy adopted by our board is using technology as a strategic asset. Here again, it goes back to competitiveness of the marketplace.
In 2001-2002, when we were 100 percent digital in radiology, nobody else in this community was digitized. Truman was out front. Similarly, our partnership with Cerner has got us to the upper range of sophistication in electronic health records.
We have created world-class venues for G.I., cardiology, for diabetes, for cancer outpatient. And the emergency room, busiest trauma center in the community for adults. In 1999 that was composed of 27 cubicles, curtains between patients. Today, it’s 54 private rooms in a very nice environment.
Q: You spoke of changing the culture of the hospital.
A: I used to use the phrase “from civil service to customer service.” I stopped using that because I don’t mean to minimize the value of civil servants. But we did raise expectations, as well as the quality, of our applicants that came to work at Truman. We had and still have very high expectations of ourselves. Secondly, we made a point to create an aesthetically pleasing environment so people felt comfortable as they walked through our corridors.
Q: You’ve made a point of bringing art into the hospital. Why?
A: The idea is about respect and demonstrating that respect for the constituencies we serve, patients, staff, physicians, visitors. And that is making a very comfortable, nonthreatening environment. If you watch the walking patterns, the traffic patterns of our patients and staff you will notice that they follow the arts.
Q: You still largely serve an urban community. What are the particular health care needs Truman deals with?
A: Chronic disease management. We are in the business of diabetes, hypertension, congestive heart failure, COPD, asthma and sickle cell, and throw in obesity. A good 70 percent of our patients have a presenting primary diagnosis of one of those conditions and oftentimes it’s more than one. We are really focusing a lot of our efforts on getting a handle on that to improve the health of the community.
So, for example, our Healthy Harvest market that we do here every Wednesday. We’ll see 600 customers and sell 4,000 pounds of produce there. That’s a big deal.
In 2006 we had a landmark requirement in the industry to not hire smokers. It makes a difference, both in our workforce, and in a statement that we are walking the talk.
And the big kahuna that hopefully will happen over the next six months is the building of a grocery store on 27th Street and Troost in the heart of a food desert. A lot of people in the hospital industry are really looking at it.
Q: Would this be the first hospital with its own supermarket?
A: That I know of. But doesn’t it make sense, given the chronic diseases that I just mentioned?
Q: Will the supermarket sell Cheetos?
A: Well, it’s going to be a full-service supermarket. But I think more importantly, there will be cooking classes. There will be dietitians on staff. And one of the most innovative, creative elements that we are trying to put together is an electronic health information crossover between the patients with those diseases that I mentioned and what they’re purchasing in the grocery store, and then having physicians writing prescriptions for groceries.
Q: Now that we have the Affordable Care Act and more people insured, how do you see the role of a safety-net hospital like Truman changing?
A: One thing that is critical for everyone is that we need to have the Medicaid expansion passed in Missouri. That’s a good thing for patients and for the communities those patients come from. It’s also a good thing for those institutions that have a disproportionate share of bad debt because that bad debt could be absorbed through Medicaid payments.
Assuming that will ultimately happen, Truman Medical Center will prosper because over the last decade we positioned ourselves to be competitive. So the patients we have traditionally seen, just because they have insurance now, won’t necessarily abandon our service because we are fulfilling their needs.
Q: What would happen if Missouri doesn’t expand its Medicaid program to cover more people?
A: It will put a severe burden on our bottom line, and the swing is dramatic. Over seven years it’s a net increase in revenues of about $50 million, if Missouri does (expand Medicaid). And if they don’t, a loss of about $150 million. That is the difference between a positive or a negative bottom line.
Q: As far as your own future, how will you be spending your time?
A: Let’s document for the record, I do have a future. I’m on a number of national health care-related committees that I will continue to be on. My wife, Joanne, and I are retaining our residence in Lee’s Summit.
And I hope to work on the Bluford Healthcare Leadership Institute. We bring some phenomenal scholars, undergraduate students from historically black universities across the country, for an intensive two-week engagement to teach them about leadership in health care in the hopes that — these kids are freshmen and sophomores — they will become interested in health care administration.
Q: Fifteen years from now, where do you see Truman Medical Center?
A: That’s just too far a window for me. I’d say five years from now, an even stronger institution. I would hesitate to say larger because one of the things I think we are on the forefront of is redefining what a hospital is.
Q: So the role of the hospital is changing.
A: Every day. The definition of the hospital may not be a building at 2301 Holmes Street. It could be at your home. It could be a grocery store.
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