For much of the past few years, Louis Giancola, the president and CEO of South County Health, has navigated the often-bumpy road of maintaining the last standing independent, acute care community hospital in Rhode Island.
While there have been suitors with local and regional groups, they have chosen to remain independent. That’s not always an easy choice in the engulf-and-devour world of hospital consolidation.
To survive, South County Health redoubled its efforts to engage with its communities. It placed its emphasis on achieving the highest rankings for patient safety and consumer satisfaction. It focuses on improving the health and behavioral health of children.
On May 31st, Giancola announced his decision to retire after 18 years, staying on until a successor is chosen. It’s a big loss.
“The decision was not an easy one because of my deep connection to the organization, staff, and the community…and it has been my privilege and honor to be part of South County Health,” he said in a prepared news release. We conducted an exit interview.
A Homey Feel
On the way to Mr. Giancola’s office, numerous people asked if I needed assistance; there was an encounter with a cancer support group and a Golden Retriever therapy dog sharing hugs in one area, and a woman playing a piano in another. A far cry from what visitors might encounter in other hospitals around the state.
Some standout points from the interview:
Giancola noted that the challenge in healthcare is about the broader issue of community, and the lack of what he calls a community ethic. Different systems are making decisions without a plan or community-wide agreement about what the system should be doing for our state and for our communities.
He cited the Vermont experience, as an example. There, regions are served by a community health team that’s supported by the health department. They work with local providers to address the social determinants of health. They perform outreach using the provider community, in order to make the maximum impact.
Vermont’s flirtation with a single-payer system didn’t pan out. But the state seems to have tried to consciously decide what kind of health care system they want. It has since move in that direction.
The Vermont Model
Giancola acknowledges he does not see RI moving in that direction. We can learn from Vermont and other states, but Rhode Island has difficulty in arriving at a common set of principles about how we are going to govern health care here.
At South County Health, they have brought a group together to explore how to make a difference. That resulted in a focus on children’s health and their behavioral health. They’ve planted roots in the community.
And it’s not strictly a South County Health project. Out of that grew Healthy Bodies, Healthy Minds–a mental health first aid program for children and adults. It’s a parenting education program, and it contains programs for people of low-income, with the attendant health and social problems.
Priorities Within the Health Care System
Giancola notes that on a larger scale, when you look at countries like Denmark, with half the healthcare costs of the US, it turns out that their high costs were not about utilization. The yearly salary for a primary care physician averages $86,000, where in the US it is about $200,000, and drugs here are 20-percent of the per capita cost of health care.
Giancola says, “So, whereas we are flogging away at reducing utilization, and I’m not saying there isn’t an opportunity there, because we all believe we can reduce the number of [unnecessary] ED visits, and we seem to use specialists more than in most other states, and we have very high inpatient behavioral health costs relative to other states – there is an opportunity to look at some of the underlying issues related to health care costs.”
Lou Giancola is the last of the old guard in Rhode Island to leave the healthcare industry. After saying that to him, he responded, “I don’t like to think of myself that way, but I guess it is true.”