Sister Marie Madeleine Shonka, president and chief executive officer of St. John's Hospital and Health Center in Santa Monica, is taking stock these days after the Northridge quake closed St. John's. Gone are her hospital and its 1,750 employees, gone are her home and her roommates.
The 67-year-old Sister of Charity, a dead ringer for the woman on the See's candy box, now lives in a 2BD, 2BA apartment with her closest friend and senior assistant, Sister Alice Marie Schwieder. Sitting in their new environs with Frank Sinatra crooning "Fly Me to the Moon" over the radio, Shonka talked about the tasks ahead.
Question: What will happen to St. John's Hospital?
Answer: \o7 St. John's will never be the same. It will be different. It will be better. The most dramatic thing will be razing the North Wing. This is an opportunity to prepare ourselves for the health care of the next century. We've known all along that there is an excess of hospital beds in Southern California and that we did not need 501 beds.
When we reopen the South Wing in August, we'll have about 150 inpatient beds. The volume of inpatients has decreased significantly and the volume of outpatients has increased. We are going to work with Santa Monica Hospital so that both of us are meeting unmet community needs. Maybe we'll develop a medical-mall type of approach, where you have multiple, walk-in clinics with dentistry, inpatient beds, emergency activities and free-standing surgery centers.
Q: Do you think most health-care facilities are moving in that general direction?
A: \o7 Outpatient is less costly and a more effective way of meeting public needs. When I first came here in 1968, about 10% of our surgery was outpatient. A patient would come in the morning, have surgery and go home at night. The rest of the surgeries, patients would stay five or 10 days. With the changes in health-care delivery, we are now finding that about 60% of our surgery is done in an outpatient capacity. We need to accommodate much fewer inpatients.
Other hospitals will be in the same situation in the future, where they will have to look at programs and services directed at the health-care revolution.
Q: What is motivating the movement toward outpatient care?
A: \o7 Doctors prefer it because it gives them a broader turnover of patients. It's more cost-effective. Many patients prefer it. Maybe the future patient is a working man who can't give up a weekday to come in for surgery. Maybe there are options for him to come in on Friday, recuperate over the weekend and get back out on the job on Monday.
I think, with the Clinton health plan, or whatever version comes out of it, that people will stay healthier as we move into preventive medicine and we won't be looking at long-term stays. We're a much healthier country now. Most people that came here in 1968 would come for maybe two or three days to get annual physicals.
Q: What is your view on Clinton's health-care plan as it stands now?
A: \o7 The goals, access and universal coverage are really very important. The challenges will be in looking at how we can accommodate access and still have reimbursement that is projected to be much less.
I am concerned about these alliances \f7 (a concept of managed competition where regional alliances representing consumers would shop among competing insurance plans for the best deals and deliver report cards to health plans, hospitals and doctors) \o7 they are talking about. I am concerned that it could become a bureaucratic maze.
Price-fixing would be a very serious problem. It has not ever worked in any of our major industries. If everything were price-fixed that would be fine, but if a hospital is price-fixed in what it can charge, but the people outside and vendors are not, then it could inundate a hospital with red ink in a short period of time.
Q: How are you dealing with all these losses since the earthquake, including the severance of all these employees who considered St. John's a family?
A: \o7 I get emotional when I talk to my employees and say goodby after all those years. I have cried. And it really kind of tears you apart after awhile. But in all fairness to them, you really have to sever relationships so they can find jobs because it is just never going to be the same.
But the loss of the sisters is one of the most poignant things for me. It's lonesome. I always enjoyed seeing them at meals, and I miss that. It's like disrupting a family\f7 --\o7 it kind of gets convulsed and it's going to get more convulsed in the next few months. But this too shall pass.\f7
Q: Some former St. John's employees have said that they feel betrayed because they say they were told that they would not get priority over other applicants for jobs when the facility reopens and because, initially, they were told that they would not retain seniority if rehired.