Editor's Note: The following is the first of a two-part series on the "Five Cornerstones for Exceptional Healthcare."

In 1989 I founded a successful hospital advisory and management firm to assist troubled community hospitals. My firm has advised and managed distressed hospitals throughout the United States. I have served as chief executive officer of 12 troubled hospitals and advised boards of many more community hospitals. During this time, I have come to appreciate there are “success” themes for distressed hospitals that recover and continue to provide communities with exceptionally good healthcare.

I call these five themes “cornerstones” and when all five - great leadership, exceptional physicians and professionals, dedicated employees and volunteers, strong community support and responsible finances - are present, no set of concerns cannot be overcome. When they are not present, no amount of money or good intentions can fix a broken hospital.

The first and most important cornerstone is Great Leadership. I have seen struggling hospitals transform themselves into wonderfully successful healthcare providers. How is this possible? Transformation must begin with the governing board; great leadership starts with a highly functioning board. Excellent boards are made up of knowledgeable local leaders with a desire to serve their community’s healthcare needs. They are business, community and religious leaders, and other accomplished people who have a good working knowledge of local needs.

Excellent boards are open-minded, have good listening skills, seek input from the community, and are not afraid to make tough decisions. They have a vision and a strategy to achieve the hospital’s goals, and do not play politics. They understand one of their greatest responsibilities is selecting and retaining an excellent CEO. Dysfunctional boards hire and fire CEOs and management companies with alarming frequency.

The best performing community hospitals attract the most talented CEOs. They live in their hospital’s community. They create a culture of service and quality that attracts the best physicians and staff. They foster a sense of pride in their community. Great CEOs stay in place five to 10 years so they can help their hospital achieve providing the best possible care for community residents. Great CEOs work hard, set a great example, and take pride in their physicians’ and staff’s accomplishments.

There are excellent and high-functioning community hospitals in the United States. They may not all be fancy, but they take excellent care of their patients, staff, and community. This is not to say it is easy. On the contrary, leading a community hospital today and doing it successfully is profoundly challenging.

No matter how bad a community hospital’s situation appears, there is always hope for a better future. The first step is improved leadership, and that begins in the boardroom. If a dysfunctional board can learn and improve, it has the opportunity to hire and keep a good CEO, who will create a culture that attracts the best physicians, nurses, staff, and volunteers. Together they can achieve the strong support of the community. Last but not least, great leaders manage finances responsibly, ensuring a stable future for the hospital. No matter how bad the situation, there is always hope when great leadership is present.

I have worked with many boards of distressed hospitals, some distressed for years, blaming everyone but themselves for their sad state of affairs. They point fingers and play the blame game endlessly. All the while their hospitals lose good physicians and employees, hemorrhage money, squander community support, and have a revolving door of CEOs and management companies. The most effective tool a troubled community hospital board can use is the mirror. If they can look in the mirror and commit to real change, there is hope. Real change must begin in the boardroom.

Exceptional Physicians and Professionals are the second cornerstone for exceptional healthcare. The best physicians, nurses, and professionals can practice anywhere; attracting and retaining them is critical to a community hospital’s long-term success.

Physicians are the anchor for the healthcare team. A small hospital that aspires to excellence in patient care needs at least two or three dedicated primary care physicians in the community. Note the emphasis on “in the community.” For a primary care physician to be truly wedded to a community, he or she should live there. Not only are they taking care of patients and family members, they are taking care of their community. They are members of a local church, they shop the local grocery stores and belong to boards and community groups as time permits.

What is the secret of attracting and retaining great primary care physicians? First, the hospital must have a great board and excellent CEO. When success with leadership is achieved, the best culture for excellent physicians will flourish. Progressive boards and CEOs know financial subsidies are absolutely necessary to attract great primary care physicians. The days of general practitioners hanging out a shingle are largely over. In today’s highly regulated and financially strapped healthcare system, most primary care physicians want to be employed by their hospital, and this generally means a subsidy will be necessary. Dysfunctional boards and underperforming CEOs complain about subsidies and refuse to offer them. These are the communities that end up with no physicians, or worse, poor quality ones who come and go like the wind.

High functioning community hospitals have excellent quality specialists available in local clinics, oftentimes coming from larger hospitals some distance away. However, local office hours and clinics can provide excellent specialty care in close partnership with local primary care physicians. Specialty clinics sometimes, but not always, may require financial subsidies as well. The most progressive community hospitals welcome regional specialists in their quest to offer a wide range of clinical services close to home.

Nurses, therapists, pharmacists, imaging and lab technicians, to name a few, round out the community hospital professional staff. As with primary care physicians, they should live in the community and take an active role there. The best performing hospitals are staffed with dedicated local residents who have as their mission to provide the best care possible to friends and neighbors. These professionals should be well paid and valued by hospital leadership.

High functioning community hospitals provide the facilities, equipment, and working environment where the best physicians and professionals aspire to practice. Excellent community hospitals have up to date equipment, clean and safe facilities, and a strong culture of quality and patient customer service. In my experience, not every hospital can have a new building or the latest in medical technology. The best community hospitals find ways to offer the best facility, equipment, and environment possible within their resources. They don’t underspend and make due with outdated equipment. They don’t overspend either, by creating a Taj Mahal hospital when modest facilities are what the community can truly afford.

Excellent boards and CEOs attract the very best physicians and professionals. When excellent leadership is present, excellent physicians and professionals want to join the staff and stay long term in the community. When excellent leadership is not present, great physicians and professionals do not come, or if they do, they do not stay long. It takes superb physicians and professionals to provide excellent care. It takes excellent leadership to attract and keep them. 

Michael Rindler is a resident of Apalachicola.