Since becoming executive vice president and chief operating officer of Brigham and Women’s Health Care in January 2015, Ron M. Walls, MD, has set his sights on working with BWHC President Betsy Nabel, MD, to steer the institution through the nation’s troubled health care landscape. As founding chair of the Department of Emergency Medicine at BWH, Walls is more than prepared for the task.
“Running a hospital, as is the case in Emergency Medicine, requires everyone to have shared goals,” said Walls, who was Emergency Medicine chair for 21 years. “You need to create a plan based on those shared goals and be willing to execute it, even when you have incomplete information. You need to know when to hold the course, even when others are uncertain, but also when to reassess and to have the courage to change the plan if it’s not right.”
In his current role, Walls’s renowned leadership, composure and strategic expertise gained a broader focus: two hospitals, two ambulatory care centers, more than 160 outpatient practices, more than 18,000 employees and a growing number of national and international affiliations. He is inspired by the institution’s storied legacy of turning obstacles into opportunities.
“The Brigham has accomplished so many firsts in health care, like the first human organ transplant and the discovery that aspirin can prevent heart attacks,” he said. “We need that kind of vision and determination to develop the new competencies and courage to launch the next era of academic medicine.”
Walls faced a number of challenges in his first year. Last February’s snowfalls established new records and crippled access to ambulatory services, eventually costing millions of dollars in lost revenue. The BWHC-wide deployment of Partners eCare from May through the end of the year was one of the biggest health IT implementations in Epic history and required outstanding effort from thousands of personnel across the system. On top of this, changes in the external payer environment presented new barriers to achieving financial success and required extensive planning to confront.
As fiscal year 2016 began in October, it was clear that new management systems were essential if BWHC was to continue to generate the margin required to meet its research, education, community service and clinical care missions. With the support of senior leaders and chairs, Walls initiated a new program of “active asset management” to allow BWHC’s many providers to make more effective and efficient use of facilities, providing better care for more patients. The program will fine-tune or redesign, as needed, oversight and management of all key areas, including operating rooms, procedural areas, inpatient beds, ambulatory specialty and primary care access, among others. Teams have begun work in these areas, and a weekly meeting of several department chairs with senior administrative and clinical leaders provides timely analysis and tactical planning to improve performance.
As his team pursues new business models and efficiencies, Walls draws on his Emergency Medicine successes to drive progress. During his tenure as chair, the department grew from four board-certified emergency physicians to more than 50, and annual patient volume more than doubled, from 38,000 to more than 80,000. The department was completely redesigned and rebuilt, implementing new and innovative care programs.
But the growth came at a cost. While quality and safety metrics were excellent, the clinical space for such high patient volume was undersized by nearly 50 percent, resulting in patient wait times of more than an hour and satisfaction ratings as low as the sixth percentile nationally.
To address this, Walls led an 18-month redesign to improve value and efficiencies at every step of the patient journey. By 2011, more than half of the department’s patients were in a bed within nine minutes of arrival, and patient satisfaction soared to the 99th percentile nationally.
These victories inspire Walls to lead BWHC toward future breakthroughs.
“In the beginning and in the end, it is all about people,” he said. “We are extraordinarily fortunate to have the absolute best talent here: in the administrative leadership team, in our chairs, among our care providers and researchers, and throughout our entire system. That, really, is the secret to success.”