ASHEVILLE, N.C. (828newsNOW) — HCA Healthcare CEO Sam Hazen said he knows people have been asking him to come to Asheville for months.

On Aug. 28, he did.

Hazen joined Mission Health CEO Greg Lowe and health care and community leaders for a Western North Carolina Health Policy Initiative discussion at MAHEC, where he addressed Mission Hospital’s recent challenges, including staffing, patient flow, capacity and community trust.

“Over the past seven or eight months, I know there have been a lot of people who have asked that I come to Asheville,” Hazen said.

He said HCA had been focused on addressing the issues that surfaced during the hospital’s CMS review process. With that process now resolved, Hazen said he thought it was time to come to Asheville and talk about what comes next.

“Our goals are 100 percent aligned with the community’s when it comes to Mission Hospital,” he said. “We want our patients to get great care. We want the hospital to be a wonderful place for our employees and physicians to work. And we truly desire the confidence of the community.”

Hazen acknowledged that Mission hasn’t always lived up to expectations.

“I will be the first to acknowledge that we haven’t achieved at all times the performance that our patients, the community and we expect of ourselves,” he said. “But we own that.”

A push to improve Mission

Hazen said the CMS review process gave HCA a chance to take a closer look at Mission’s operations and identify areas that needed work.

He said the company found gaps in governance, accountability and its culture of excellence. Mission has since changed policies and procedures, streamlined some workflows and changed its clinical system, he said.

HCA also added resources after identifying staffing gaps.

Staffing remains one of the biggest challenges.

Hazen said Mission has more temporary workers than HCA would like and needs to build a more permanent workforce. At the same time, he said the hospital’s volume has grown more than 20 percent since HCA acquired Mission, while its registered nurse headcount has increased 22 percent.

“We still have a need to develop a permanent workforce,” Hazen said.

He pointed to HCA’s investments in nursing education, including the Galen College of Nursing, as well as partnerships with local schools.

Mission also has partnerships with Blue Ridge Community College, Asheville–Buncombe Technical Community College and Western Carolina University to expand nursing education in the region. The company is funding academic positions at the schools and providing adjunct faculty, according to information presented during the meeting.

Hazen said Mission is also trying to improve its reputation among potential employees.

“Some people think it’s a horrible place to work,” he said. “It is not. It’s hard. Health care is hard in every hospital in this country.”

Changing that perception, he said, is part of the company’s workforce strategy.

Mission needs more capacity

Hazen was blunt when asked about the biggest barriers facing Mission.

“We’re full,” he said.

The hospital needs more beds and more capacity to handle the demand for complex medical care, he said. Workforce shortages add another constraint.

Hazen said Mission’s patient-flow initiative is aimed at getting patients through the hospital more efficiently, including reducing emergency department wait times and improving the transition from the ER to inpatient units.

“We have to be very good,” he said. “That’s why one of our plans is — and I’ve told the team at Mission — because they’ll say, ‘Oh, we benchmark well against the rest of the large hospitals and HCA.’ I said, ‘That’s not your issue.’”

The issue, Hazen said, is creating enough capacity for Western North Carolina regardless of how Mission compares with other hospitals.

“Your issue is to create capacity for the region regardless of how well you perform against our other big hospitals,” he said.

Trust remains a problem

Community trust came up repeatedly during the discussion.

One participant asked how Mission planned to rebuild long-term trust and whether HCA and Mission leaders would communicate more directly with the community about their progress.

Hazen pointed to Mission’s community advisory board and patient-family advisory committee, but said HCA is open to other ways of communicating with the public.

“We’re open to other methods that are productive for everybody to create whatever transparency is needed to continue a path forward,” he said.

Sen. Julie Mayfield, who participated remotely, said more transparency about what happened at Mission over the previous six months could help.

She also suggested Mission’s advisory committees become more visible in the community.

“There can be and are great things happening at Mission, and then there’s a lack of trust with the community,” Mayfield said.

Hazen said he understood that trust wouldn’t be restored simply by asking people to believe in HCA.

“I know I can’t come in here and say just be confident in us,” he said. “We have to earn that, and we are determined to do that.”

He described his visit as an effort to “hit the reset” with the community.

“We hold ourselves to account,” Hazen said. “You all should hold us to account, as well.”

Hazen challenged on staffing, profits

Hazen also faced a question about HCA’s business model and Mission’s profitability.

A participant cited a report by a Wake Forest University professor who has followed HCA’s acquisition of Mission and said the report described Mission as one of HCA’s most profitable hospitals.

The participant also questioned whether HCA’s business model of reducing staffing was connected to safety concerns and the community’s distrust of Mission.

Hazen disputed that characterization.

He said Mission was reasonably profitable before HCA acquired it and said he had not seen the report being referenced.

He also said clinical staffing has not been reduced in the way suggested.

Mission’s registered nurse headcount has grown faster than patient volume since the acquisition, Hazen said. Where staffing has been reduced, he said, it has primarily involved administrative redundancies, including in information technology and the business office.

Hazen said HCA’s size allows the company to reduce administrative costs and share practices across its hospitals while continuing to invest in Mission.

HCA has invested nearly $750 million in Western North Carolina since acquiring Mission, Hazen said.

Rural hospitals also discussed

Hazen was asked about Mission’s smaller regional hospitals and whether HCA plans to maintain or expand services at those facilities.

He said HCA has invested heavily in the hospitals and has no plans to shrink their programs.

Hazen said HCA recently approved a little more than $3 million in capital investments for equipment and technology at its regional hospitals.

He specifically discussed Blue Ridge Regional Hospital, which he said was hit particularly hard by Tropical Storm Helene.

The hospital lost water for 52 days and also lost its sewage system, he said.

Hazen said HCA has since added several providers in the area, including primary care physicians, and is bringing in a general surgeon. He also cited OB-GYN, orthopedic and urology services.

“We’re in a completely different position,” he said.

Hazen acknowledged that Mission’s regional hospitals aren’t meeting every expectation of their communities but said recruiting providers to rural areas remains difficult.

‘The end of the beginning’

Hazen said resolving Mission’s CMS situation shouldn’t be viewed as the end of the work.

“The CMS process, the resolution of that process is not the end,” he said. “It’s the end of the beginning.”

He said HCA’s goals are to provide good care, make Mission a good place for employees and physicians to work, and regain the community’s confidence.

“We just need to be even better,” Hazen said.

The Western North Carolina Health Policy Initiative hosted the discussion as part of its work bringing health care, education, government and community organizations together to address regional health issues.