A new boss, a new day
What happens when a community institution charged with keeping people healthy itself gets sick?At its worst last year, Aspen Valley Hospital was hemorrhaging nearly $1 million a month and had barely enough money to keep its doors open for more than a few weeks. Perhaps most dangerously, the hospital’s internal culture began to decay; inside the doors and out in the community, a cancer of discontent was spreading.After various actions were taken by the hospital’s board – excising the CEO, the CFO and 36 of the nearly 400-strong work force, stabilizing revenue flows – AVH managed to stay alive and avoid bankruptcy. By mid-July, interim CEO Dr. Bob Karp declared, “We’ve managed to stop the ship from sinking.”Still, challenges remained. The patient didn’t die, but how to make him healthy? How to regain trust with employees, patients, the public? The affair, one nurse told the hospital board in a public meeting, had left a “permanent gaping wound in the morale of the hospital.”In this setting, the hospital announced the hiring of David Ressler as new chief executive officer. His first day of work – Sept. 1 – was an exciting and long-awaited one for the staff. Several employees spoke that day of “finally having a moral compass to guide this place” and how “this is a tired hospital that needs someone to help us move on.”AVH’s white knight, they hoped, had finally arrived.Who’s the Boss?Six weeks later, Ressler is sitting at a table in his office. A large ladder, set up to continue refurbishment begun when he arrived, blocks his entrance to his desk. His walls are still lined with the same generic “aspen grove in autumn” paintings and pictures as when he moved in. Only a hastily arranged photo ensemble of his wife, Julie, and two children, ages five and seven, speak of his arrival. Ressler’s a young-looking 40-year-old, an avid outdoorsman, but in his office, he’s all business. His first priority, it seems, is not to waste time settling in, not when an institution and a community are practically holding their breath to see what he does first.”There’s been a lot of pressure,” Ressler says. “I know a lot of people are just waiting and seeing.”It eased a lot of nerves when Ressler announced at September’s monthly board meeting that his first priority was to shore up morale in the hospital. In fact, ask Ressler about specific plans for the hospital and its nearly $50 million budget and he demurs. Much of his first month on the job, he says, has been spent simply meeting with and listening to staff.”My first priority is to our employees and doctors,” he says. “I think that’s evidenced by the fact that I haven’t really done anything concrete or made any big decisions in my first six weeks here. I’m still orienting myself.”During this orientation, Ressler has been careful and diplomatic in his interaction with the hospital board. Through the financial crisis, the board was forced to dip unusually deep into hospital affairs, even going so far as to micromanage AVH’s finances. A perception grew among staff and the public that all hospital business had essentially become the board’s business.Ressler says he’s in close contact with the board and former interim CEO Bob Karp, using both as “sounding boards” as he gets settled in. Ask him where he draws the line, however, and it becomes clear who is running the show.”As we move forward my relationship with the board will evolve over time and in that process you define roles and limits,” he says. “I have the reins – make no mistake about it.”Board president John Sarpa agreed. Sarpa, who along with fellow board member John Jellinek were the key decision makers during the financial crisis, said in an interview last week that the board feels “relieved” to have a new, permanent leader in place.”We are referring almost all decisions now to Dave,” Sarpa said. “We’ve made it very clear to him that he’s the head of operations.”A past that hints at a futureRessler says it is still too early for him to offer any specific prescriptions for AVH. Right now he says he is going “broad, not deep,” meaning that he’s considering a wide spectrum of possible improvements while not yet offering any specific solutions.Still, Ressler’s track record at his previous hospital offers hints as to what Ressler brings to Aspen and what he may have in mind for AVH. Before leaving for Aspen, Ressler spent four years as head of the Sierra Vista Regional Health Center, a hospital in southeastern Arizona that serves some 60,000 residents. Sources within the Arizona hospital credit Ressler with far-reaching changes to the culture at Sierra Vista, a clear plan for the future, and an ability to boost staff morale.”When he was brought in here, there was a similar situation [to AVH] in terms of low morale. The culture was screaming for change,” former Chief Nursing Officer and now interim-CEO at Sierra Vista Linda Wojtowicz said. “Under David’s leadership, all that changed.”Wojtowicz said Ressler was hired as a “change agent” at a time when Sierra Vista was struggling to cope with decreasing revenue and an exploding local population. Ressler turned the ship around.”We were dealing with significant losses,” she said. “But we’ve had very positive bottom lines in the last few years, thanks in large part to David’s leadership.”A Strategic PlanIn Arizona, Ressler laid out a “strategic plan” for Sierra Vista, which included the construction of a new hospital, developing affiliations with large metropolitan hospitals in Tucson, and the expansion of elective services to bring in more revenue. It’s a formula, Ressler says, that can work at AVH. An affiliation with larger specialized hospitals and the expansion of elective surgery services will likely be parts of his plan. And building a new hospital, an idea that was essentially shelved when AVH ran into financial straits, remains a likelihood within a few years. But before any of these plans move forward, Ressler is quick to point out, the hospital will continue to watch finances closely. For example, the hospital’s Rifle-based billing office, the epicenter of the recent financial crisis, has been moved to Carbondale so that AVH officials can better monitor its operations.”We’re no longer under water, but we are just skimming the surface financially. Once we gain some altitude we’ll have more options,” he says.Still, after months of keeping its head down and boring through statements and audits, the hospital seems ready under Ressler to start looking to the future.David and Goliath working together?Before Ressler arrived, the hospital was negotiating an agreement with the Hospital for Special Surgery (HSS), a major orthopedic center in New York City. Under the agreement, AVH would buy the right to use the New York hospital’s name to attract patients to Aspen for joint replacements and other elective procedures. Ressler is not sure the New York affiliation is the right one for Aspen, but he says the reasoning behind the negotiations was sound. He says having the name of a big-city institution on AVH’s door will not only help attract patients from across the nation, but ensure Aspen’s own patients stay at home. This could be a crucial boost to revenue, particularly during Aspen’s offseasons.”We’ve had no specific conversations yet. But it’s a concept I support,” Ressler says. “When we talk of affiliations with other hospitals we also mean Valley View [in Glenwood Springs] and Denver, not just the Cleveland Clinic or New York. We have to offer the services our patients need so they don’t go elsewhere.”OutsourcingRessler would also like AVH to outsource certain hospital operations to large administrative companies. Currently he says the hospital is nearing an agreement with First Consulting Group (FCG) Inc., a medical consulting group in Long Beach, Calif.Although details are yet to be ironed out, FCG will likely take charge of much of the hospital’s paperwork, including medical records and billing. Most Aspen employees currently working in these departments will become employees of FCG. In the future, outsourcing may cost some of these employees their jobs. But to Ressler, it’s worth it.
“This is something I believe in,” he says. “It’s not just to save money, although that might be part of it. It’s about tapping into the wealth of knowledge these [outsourcing] firms have.”A new hospitalPart of Ressler’s updated strategic plan will include a “master plan” for the hospital building itself. Massive refurbishment to the hospital at its current location, or perhaps even a new site altogether, are still possibilities. But such decisions are likely a long way off.Right now, Ressler says he needs time to continue his evaluation process and then implement his decisions. Before any of that begins, however, Ressler is working on a “dashboard” of management accountability. The dashboard, which will be available to the public online, will offer quick-reference measurements of the hospital’s performance against last year’s numbers. Finances, patient and employee satisfaction will all be laid out in the open. Ressler wants people to see how and what he’s doing.To many, this equates to a new AVH and a fresh start, even before talk of a new building begins.”We went through a tough time last year,” AVH physician representative John Przonek said. “The whole staff here is looking forward to working with him.”
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