A message from James Hereford: Creating a stronger health system for our patients  and communities

Changes across Fairview Health Services will help us make healthcare more affordable, accessible, and equitable for you, the people we serve.

Our health system is taking several important steps forward to realize our bold vision to bring breakthrough care to more people, and to address the financial challenges that all healthcare systems, including ours, are facing.

Achieving this transformation requires change, and change is both exciting and difficult. Together, we will rise to meet this moment in order to create healthcare that is more affordable, accessible, and equitable. Healthcare that makes our community better, for everyone, today and long into the future.

We have already taken steps along this path in our partnership with the University of Minnesota and in the way we work with community organizations, bringing academic and community medicine closer together. But more is needed to achieve the future we want.

To realize this vision, we are announcing a number of changes to our organization:

East Metro Realignment

Bethesda Hospital

Evolving to meet the needs of our community is not new to us. Most recently, our team moved quickly to convert Bethesda Hospital into one of the nation’s only COVID-19 hospitals. Now, as we move to a new phase in COVID-19 care, Bethesda will once again transform to meet another urgent community need.

In partnership with Ramsey County, Bethesda will help address the homelessness crisis, providing shelter this winter to hundreds of Minnesotans, giving people necessary space to rebuild their lives while helping to reduce COVID-19 spread among the unsheltered. Ramsey County leaders will address a lease agreement for the Bethesda facility beginning this week at their board meeting. We should all be proud to once again partner with community leaders to address a serious and important need.

Our innovative and successful cohorting approach to caring for COVID-19 patients will continue, with a centralized COVID-19 unit located at St. Joseph’s Hospital. Over the next several weeks, COVID-19 patients housed at Bethesda will be transferred to St. Joseph’s. COVID-19 care will continue at St. Joseph’s through 2021, or as long as community need requires. 

St. Joseph’s Hospital

For more than a year, we have been actively working with stakeholders in St. Paul and the East Metro to understand how to best meet the community’s needs. We know that an acute care hospital – that sits within blocks of three other acute care facilities and two other emergency departments – does not appropriately meet the needs of the community. In fact, Minnesota Hospital Association data shows that 72 percent of the cases in our emergency room were considered "potentially preventable visits" with appropriate primary care. Our current care model is providing the wrong kind of care in the wrong setting, at high cost to us and inappropriate care for patients.

More than 300 community conversations over the past year told us that access and affordability are real barriers to care. A successful approach to addressing health equity must focus on wellness, not only on sick care. It has become clear that, in order to best serve the community, we must look at better care models.

To meet the needs of the community today, St. Joseph’s will be reimagined as a community hub of health and wellness, creating a one-stop campus that addresses the social risk factors of health, focused on three areas: health, housing, and supportive services. Our vision includes a focus on accessible, affordable, and equitable care. We have asked the Sisters of St. Joseph of Carondelet to join us in this visioning process, and we hope that the reimagined St. Joseph’s site will potentially include a hub for St. Mary’s Health Clinics, among other innovative approaches, in the future as part of our continued partnership.

We are working to co-design this new hub of health and wellness with the community, government partners, and other partners who have dedicated themselves in service to this community, as well as our longstanding partners in the Department of Family Medicine and Community Health.

Our existing inpatient mental health beds will remain at St. Joseph’s through 2021. We are actively exploring how we will continue our leadership in providing mental health services in our region, including our ongoing pursuit of partners through the Request for Partnership process kicked off earlier this year.

As we continue our focus on creating a simpler patient experience, specialty services currently at St. Joseph’s, such as cardiology and neurology, will be moved to other facilities in the East Metro. With the transition of services, the emergency room that utilizes these services at St. Joseph’s will be discontinued. Currently, more than 55 percent of St. Joseph’s patients come from outside of the city of St. Paul. We are confident in our ability to continue to deliver excellent care to our patients across the East Metro.

Improving the patient experience

We are also announcing several other important steps that will move us toward our vision of a new kind of healthcare system.

Between now and the end of 2020, we will deploy a new ambulatory care model focused on health ‘hubs,’ expanding services across more than 40 clinics and primary care locations, repositioning specialty care through comprehensive ambulatory centers and fully leveraging new consumer demand for virtual care. To successfully implement this model, we plan to consolidate 16 clinic locations in Minnesota and Wisconsin with other nearby locations by the end of this year. 
You can learn more about these changes here.

Patient experience is central to well-being and successful care. We will continue our commitment to single-occupancy hospital rooms across our system, which increases flexibility, provides patients with more privacy, and enhances our infection-prevention measures. This work has already begun with construction at Southdale Hospital and will soon begin at University of Minnesota Medical Center and other sites. Read more about these changes here.

Among our many learnings from COVID-19 is that patients are willing and eager to embrace new care delivery methods – from virtual care to drive-up vaccination clinics. Connected digital care will help us embrace these changes and evolve with and for our patients. This fall, we will integrate onto a single Epic platform, which will dramatically improve our patients’ experience through advanced mobile applications and will accelerate our ability to make the day-to-day work of our clinical staff and other users of Epic easier.

The development of advanced care maps will help us deliver more effective and consistent care to our patients. They will also help patients better navigate their experience together with their care teams. These care maps, developed by our physicians, nurses, and other caregivers, will be the key to delivering highly reliable care that delivers the best clinical outcomes, the best experience, and the best value for our patients.

As the largest mental health provider in the Upper Midwest, we must lead and innovate. To start, we will open EmPATH (Emergency Psychiatric Assessment Treatment and Healing) units across our system. This innovative and proven care model provides a calmer, living room-style environment for patients with urgent mental health needs, connecting them to the right outpatient resources and helping them avoid traumatic emergency department visits and lengthy inpatient stays. We will introduce EmPATH in two locations over the coming months, starting at Southdale Hospital. Untreated mental health care deeply affects the well-being of people, communities, and society, and we will continue in our commitment to this important care.

Addressing our current financial vulnerabilities

In the first six months of this year, our system lost $163 million. It’s a staggering number. It was, of course, deeply impacted by the unprecedented health threat of COVID-19 – and our heroic, life-saving response. But COVID-19 did not create this problem; rather, it further exposed the profound challenges we face and the unsustainable economics of healthcare today.

We’ve already taken painful steps to address our financial challenges, including furloughing staff and not backfilling open positions. These steps were critical but were not enough to close our financial gap. With the changes we are announcing today, we will eliminate approximately 900 positions across our system by the end of the year. This is less than 3 percent of our total workforce. Wherever possible, we will help colleagues transition to open roles within the system. Currently, we have approximately 1,200 available roles, both clinical and non-clinical. It is important to us to retain as many of our colleagues as possible and find ways for them to continue to make meaningful contributions within the Fairview family.

These are incredibly difficult decisions that affect respected colleagues and friends. They are among the hardest decisions an organization must make. They are also critical to our future as a health system.

Looking ahead

The changes we announce today are steps towards the transformation that we and health care systems need. While we must address our financial challenges, ultimately this is about becoming a thriving and innovative health system – one dedicated to helping and healing patients and lifting up our community. If we wish to improve health outcomes and experiences for our patients, we must be willing to do things differently. If we wish to deliver more affordable, more accessible, more equitable care for our patients, we must act. We do so in order to best serve our patients and communities, now and well into the future.

James Hereford, President and CEO, Fairview Health Services