A Once-in-a-Generation Transformation at an Academic Public Hospital During Federal Funding Uncertainty

Area of Science:

• Healthcare Management
• Public Health Policy
• Medical Education

Background:

• Public hospitals and academic medical centers (AMCs) face increasing fiscal and regulatory challenges, impacting long-standing partnerships.
• The 140-year affiliation between Los Angeles General Medical Center (LA General) and the University of Southern California (USC) was recently threatened by these pressures.
• Changes in Medicaid and federal research funding create an uncertain environment for healthcare institutions.

Purpose of the Study:

• To document lessons learned from a two-year restructuring of the LA General and USC relationship.
• To evaluate the impact of this workforce transformation on patient care quality.
• To provide insights for other public hospitals and AMCs facing similar challenges.

Main Methods:

• Extracted hospital-wide mortality metrics from the Vizient Clinical Database.
• Retrieved Leapfrog hospital safety scores from public releases.
• Monitored mortality rates and safety scores during a 21-month period of significant workforce restructuring and hiring.

Main Results:

• LA General successfully hired 273 physicians, dentists, and allied health professionals across 19 departments within 21 months.
• Hospital-wide observed and observed/expected mortality rates significantly declined post-hiring initiation.
• Leapfrog patient safety scores improved during the workforce hiring period.

Conclusions:

• Public hospitals and AMCs can successfully restructure and transform their operations to maintain vital affiliations amidst fiscal challenges.
• Intentional organizational restructuring and cultural adaptation are key to strengthening partnerships during times of funding uncertainty.
• Workforce transformation, even when rapid, can be managed to maintain or improve patient care quality.