Steven Kelley is the president and CEO of Ellenville Regional Hospital. It’s a hospital that’s gained state and national prominance for the quality of its care; Kelley serves as the chair of the Health Association of New York State Board of Trustees, and has been asked to speak regionally and nationally about the quality of care that Ellenville has been able to achieve. 

Speaking with the River Reporter on Friday, October 16, Kelley mentioned a meeting he’d been in the day before with Sen. Chuck Schumer and the heads of many of New York State’s larger hospital systems. 

“Most of my colleagues, I think, are struggling to meet the day-to-day demands, the firefighting of the crisis of the moment, because it’s an endless succession of crises that overlap each other, and some of them last for a long time,” he said. 

Long term, Kelley is concerned about what happens to hospitals faced with an increasing amount of bad debt. 

The way health care works, he said, is that you’ve either got health insurance that covers your care, or you don’t. Those who have insurance can pay for their care; those who don’t leave hospitals with bad debt. 

If, say, three million people lose their health care coverage in New York State, that leaves hospitals with an additional 15 percent in bad debt, according to Kelley. 

“I think it’s gonna be really, really tough,” he said. “We have a lot of hospitals, health care organizations that do not have a lot of cash, are not making money now. Not very many can afford 15 percent more bad debt. That’s a lot of loss.”

Facing financial difficulties, Kelley sees opportunities for improvement in the health care system. While he said hospitals should be looking for improvements whatever the conditions, the current environment may, paradoxically, open up opportunities for change. 

“We can make it better; we just have to rethink it,” he said. “We can’t rethink things when times are good, because when they’re good, you don’t want to change anything... I think we should endlessly be looking to make it better. My goal is to have some  of these ideas get discussed, and they’re going to be. We’ll see. Some of them will stick, I hope, and we’ll create value for the system and for our patients, and for our hospitals, so that they’ll be able to survive in this more difficult environment.”

Industry-wide efficiencies

Kelley sees opportunities for improvement in the health care industry through improved efficiencies.

“We need to turn around health care,” said Kelley. “We need to figure out how we can reimagine health care without tanking our whole system, because we really have a good system, but we have a lot of things that are very costly. We have to have our partners in government and in the regulatory structure and under the governor’s leadership as well as the leadership of the legislature to be willing to make changes that are going to remove unnecessary costs.”

One example Kelley gives involves the hospital’s required state reporting. The state requires the hospital to proivide daily and weekly reports; however, the hospital also reports its data seperately to New York’s statewide health care information network. “They should just get that data from there,” he said. “There’s no reason for us to report anything seperate.”

Kelley also supports the use of AI technology as part of the hospital’s documentation process. 

Nurses might spend a quarter to a third of their time typing up and documenting what they are doing, said Kelley. “Imagine if they didn’t have to do that, [if] that was all electronically uploaded from ambient listening that then transcribes the encounter.”

The staffing shortages hospitals face come, in part, from the amount that medical staff members are expected to do, argues Kelley. If technology could lighten the load for the doctors and nurses that hospitals have, the workload at hospitals would be right-sized for the current numbers of staff they have. 

Successes in Ellenville

Kelley’s efficiency-centered focus has seen notable success in Ellenville. 

Kelley highlights emergency room waiting times as one of the areas the hospital has been able to improve. Patients’ biggest complaint about emergency rooms, generally, is the amount of time they have to wait, he said. That time is broken up into moments of engagement—a nurse makes a triage judgement, a doctor makes an assessment, a patient gets a CAT scan, and so on—separated by intervals of waiting. 

“We spent almost two years doing interval analysis on all those intervals [of time spent waiting for care] and measuring how long they took,” Kelley said. “Then I challenged our people to figure out how to reduce the waiting time—not the time spent with patients, the waiting time.”

The work had results. “Our average length of stay here is around two hours,” said Kelley. “Which, if you go to any place else, you really need to pack a sandwich, a pillow, a teddy bear and a blanket, because it’s going to take a while.”

Ellenville found success in another area as well, through redefining how patient outcomes were measured. 

The hospital has a lot of in-patient rehabilitation, said Kelley, with older patients especially needing significant rehabilitation. He wanted to improve outcomes for those patients, and went to the hospital staff to ask if they could develop a tool to measure patients’ functional outcomes. 

“They didn’t want to do it,” Kelley recollects. “I couldn’t understand. Why wouldn’t you want to give the patients everything you would want to give them? Why wouldn’t we want to do our best? And they were like, ‘Well, Mr. Kelley, you know, you’re asking us to deviate from the Standard of Care’.”

General hospital procedure is to follow a set Standard of Care, not to promise outcomes; if hospital staff can say they followed the steps laid out in the Standard of Care, that protects them from malpractice lawsuits. Kelley said after realizing that was the hang-up, he challenged his staff to think of the Standard of Care as the bare minimum of care to provide, and to figure out what could be done beyond it to best help patients. 

“They were like, ‘Oh, that doesn’t sound so bad,’” said Kelley. “They came up with a tool, we measured it for six months, and then I set them free.” After around a year, functional outcomes for the hospital’s rehabilitation patients improved by roughly 17 percent, he said.