Health Smart
With support from residents, a community hospital is improving access to healthcare for local residents
By Sheryl S. Jackson
Stories about small hospitals closing due to financial losses, increased costs and the need to consolidate services at larger institutions have appeared in newspapers around the country since the beginning of 2009.
A very different hospital story is reported in Lithonia, Ga., a suburb of Atlanta.
DeKalb Medical at Hillandale, a 100-bed, state-of-the-art hospital, just celebrated its fifth anniversary. The hospital is part of the DeKalb Medical Health System, which also operates a 627-bed hospital in Decatur, Ga., along with a variety of outpatient service locations and physician practices.
The difference between DeKalb Medical at Hillandale and many of the community hospitals that are closing is that Hillandale was designed from the beginning to be financially sound; it does not serve as a “feeder” facility for the larger hospital. In fact, Hillandale offers top-notch diagnostic and treatment services that mean most patients can stay in the community, and income from their care supports the hospital’s growth. Another key factor in the hospital’s success is the community support that made its construction possible.
A Long Time in the Making
Plans for the Hillandale hospital began in 1974 with the development of a four-phase program for a medical campus that included medical office buildings, outpatient services and a full-service hospital. Forty acres in the Hillandale community area of South DeKalb County were purchased in 1976. What no one predicted was the more than 30 years it would take to work through a myriad of legal and regulatory battles required to prove the need for more hospital beds and demonstrate that DeKalb Medical’s proposal was better than the proposals submitted by competing hospitals.
Dr. Tyrone Malloy (left, who also holds a juris doctor) is chief of the medical staff at DeKalb Medical Hillandale and was involved in the efforts to gain approval for a hospital since he began practicing obstetrics-gynecology in the Hillandale community area in 1981. “I was the only African-American ob-gyn in the South DeKalb area at the time, and my practice grew quickly,” he says. “It was obvious that South DeKalb was burgeoning, with an African-American middle class population that was growing quickly,” he explains, adding that the burgeoning population and increasing traffic, which lengthened travel time to other hospitals, made a hospital in South DeKalb important to ensure citizens had easy access to healthcare.
Even though final approval for Hillandale was not received until 2002 and the hospital did not open until 2005, in 1986 the hospital system moved forward with Phase I of the plan by building a medical campus on Hillandale Drive. In 1994, an outpatient diagnostic and treatment center with laboratory, imaging and rehabilitation services opened on a 40-acre campus in Lithonia, and 10 physician suites were built so that much-needed doctors could move to the area. In 2000, an outpatient facility that included an outpatient surgery center, observation beds and a 24-hour minor-emergency center, as well as a second physician office building, opened in Lithonia..
Zeroing in on African-American Health Issues
Because the area in which the hospital is located is predominately African-American, there are some key health issues on which the medical community focuses, says Clay Fowler, vice president and administrator of DeKalb Medical at Hillandale. “A recent report from the county’s health department shows that the rate of breast cancer for white women in our county decreased by 13 percent between 2002 and 2006, but the rate of breast cancer for black women increased by 1 percent,” he explains, adding that the hospital and physicians are in the early stages of forming a roundtable group of physicians to address the issue and develop plans to improve education and early screening.
“At this point, we don’t know why breast cancer is increasing in our African-American population or why breast cancer is the leading cause of cancer deaths,” admits Dr. April L. Speed (left), a breast surgeon. Speed completed a prestigious breast surgical oncology fellowship with an emphasis in oncoplastics at MD Anderson Cancer Center in Houston, Texas, but chose to set up her private practice at the Hillandale hospital in 2009. Her subspecialty of oncoplastics means she will work with plastic surgeons to perform breast reconstructions at the same time breast surgery for cancer, such as a mastectomy, is performed. This approach to surgery means that women do not have to undergo two separate surgeries.
“I wanted to work here for several reasons,” says Speed. “There is a real need for physician specialists in this area, and I wanted to practice in a community setting.”
Community Focus Draws Doctors, Patients
Community is a key word for the hospital and physicians at Hillandale. Throughout the 30-plus years it took to gain state approval to build the facility, community members worked alongside hospital representatives and physicians to lobby for and show support of the hospital. Even today, an advisory board that includes community members offers guidance and feedback for hospital activities.
“The support for this hospital and the physicians who practice in the area [were] key [factors] in my decision to work here,” Speed continues. “I also like being able to tell patients that they don’t have to travel to another hospital for tests or treatments.” Services available on the hospital campus for diagnosis and treatment of cancer include imaging services that range from digital mammography to MRI, radiation treatment, chemotherapy and surgery. “Patients will ask where they need to go for the test I’ve ordered, and I’ll just point to the next building,” Speed says. “I can have everything done here?” is often the response, she adds.
Because the hospital was built only five years ago, it is capable of handling digital records in all areas, including electronic health records that are available to physicians. “The use of electronic records gives me the opportunity to receive lab and imaging results more quickly and to see my patient’s entire record, not just what she may remember to tell me,” says Speed. Also, a computerized physician order entry system used by the hospital improves patient safety because hospital staff members don’t have to “interpret” a physician’s handwriting, she notes.
Speed is not the only highly trained physician to move to the area in the past year. Dr. Augustine Conduah (right), completed a fellowship in sports medicine at the Hughston Sports Clinic in Columbus, Ga., a leading institution for orthopedic and sports medicine research, education and treatment, prior to opening his orthopedic practice at the Hillandale hospital.
“Although there are other orthopedists in the area, it is still an underserved area,” says Conduah. “Most of my surgery is performed at the Hillandale hospital, but I can also schedule surgeries at the other DeKalb Medical hospital.” Patients appreciate having a choice of location, and most do choose the hospital closest to where they live, he says.
Conduah says that even though most residents of the area know there is a hospital close by, not everyone knows how many services are available.. “Community talks about specific types of injuries and treatments are one way I’m helping to educate the community,” he explains. “I’ve also partnered with a local school as the athletic team physician, and I’m participating in the high school mentor program as two ways to give back to the community that supports us and to let people know about the healthcare services here in the area.”
Not only does Hillandale sponsor community talks on a wide range of health topics in the community room of the hospital, but Conduah and other physicians also travel to local retirement communities, churches and clubs to talk about health issues and the hospital.
According to Fowler, Hillandale addresses the high rate of cardiovascular disease in the U.S. African-American population by offering free community presentations and coupons for free peripheral vascular screenings. “We distribute the coupons at physician-led community talks on heart health issues,” he says. “Over half of the people who follow up the talk by scheduling a screening have abnormalities.” Early identification of potential vascular problems enables the patient to see a physician for treatment before he or she suffers a heart attack or stroke.
Sound Leadership Spells Success
“Another reason I like practicing here is the attitude of the hospital leadership and staff,” says Speed. The focus is on meeting needs of the community, and there is no resistance to trying new approaches. “It’s a good place for physicians because we really have an opportunity to offer input, and hospital leaders listen to us.”
Hospital managers and staff members also listen carefully to what the community needs. When the hospital first opened, the emergency department was quickly operating at capacity, says Fowler. As waiting times became longer, the emergency department staff came up with a plan to improve triage and get patients seen by a physician more quickly. “We dramatically improved our service to our patients,” he explains, noting that as more people have learned about the hospital’s emergency department, the numbers of patients continues to grow. “We will see more than 50,000 patients in our emergency department this year.”
Also, the type of patient seen in the emergency department has changed, says Fowler. Five years ago, the majority of patients were seen for minor illnesses or injuries, but as the emergency department’s reputation for being able to handle serious emergencies grew, the majority of today’s patients are truly emergency as opposed to medical clinic-type cases, he says. “The quality of our emergency department physicians and the ability to be admitted to our hospital, if needed, in their own community, have made us the emergency department of choice for people in this area,” he adds.
The success of DeKalb Medical at Hillandale can be attributed to the community-wide effort that resulted in the expansion of healthcare services in the area, says Conduah. “This hospital has a great future because everyone – community members, physicians and hospital staff – has a vested interest in its success.”