On To The Future October 2006

by Gary Rapaport

Gary Rapaport has been leading SUTTER Delta Medical Center for the past year. He describes his life and the vision he has for improving health services for all area residents.

East County residents would like to avoid driving “over the hill” to places like Concord, Oakland, and San Francisco for essential services. Besides the simple annoyance of having to go so far, we all know that — more often than not — the drive itself is a difficult one, with far more vehicles using the few routes out of East County than our highways were originally planned for.

Sutter Delta Medical Center is growing its resources to help our residents remain close to home while obtaining essential health services for everything from routine examinations to major operations. People complain about the drive down Lone Tree Way, but that trip is nothing compared to Highway 4 or Vasco Road. The issue of Brentwood or Discovery Bay residents having to drive to Walnut Creek or San Francisco to buy a perfect piece of art for a living room wall is completely different than the problem of having to make that trip when you aren’t feeling well or when your life may even be in danger.

At Home with Health Care
I was born and raised in Oakland and completed my master’s program and a residency in Hospital Administration at Peralta Hospital, which was the place where I first saw the light of day. In fact, when I started working in that hospital I was assigned an office that turned out to have belonged to the ObGyn doctor who delivered me.

Throughout my life I have been surrounded by people working in medical care. My father is a retired pediatrician. My wife, Vicki, is a pediatric nurse who worked at Children’s Hospital in Oakland before we met. In fact, my father worked there at the time and knew Vicki before she and I knew each other. My grandfather, Walter Rapaport, was a psychiatrist who served as hospital administrator at Agnews State Hospital in San Jose, one of California’s first institutions for the mentally ill, which today bears the name, Sun Microsystems/Agnews Developmental Center. My grandfather worked at Agnews for several decades. A building on the campus was named for him in recognition of his outstanding service to the mental health field.

Besides his work with Agnews, Grandfather Rapaport also maintained a statewide consulting psychiatry practice through which he examined accused murderers at the request of law enforcement agencies throughout Northern California. Following his assessment he would tell the prosecutors’ office whether or not an accused individual was fit to stand trial. For a time my grandfather’s testimony was a key factor for most cases headed for murder trials throughout the region.

In 1987 Vicki and I and our two children moved to Oakdale where I took a position with the local hospital. Besides being a nurse, Vicki, who has the soul of an entrepreneur, decided she wanted to do something completely different, and with my support, she bought a bakery in Modesto that had previously been owned by Mrs. Fields. We refurbished the place and she began providing Modesto with its first upscale coffee service.

When we finally decided after two years that the commute to Modesto from Oakdale was too difficult, we sold the business. It was necessary for Vicki to be on-site when the oven quit working, for example. Her presence was also required when her baker lost his temper and threatened one of Vicki’s customers! Because the experience of running the bakery provided my wife with some on-the-job training in supervisory skills, she developed more empathy for the situations I face daily in my management role.

After selling her bakery/coffee shop, Vicki recruited physicians for a firm in Placerville and is now in the process of opening her own recruiting firm here in East County. She also kept llamas for seven years and maintained them as a source of wool for her spinning wheel. Her newest hobby is to raise and show Havanese dogs which are “cousins” of Bichons but with more hair.

Joining the Sutter Family
I first encountered Sutter Health in 1978 when I took a job managing the Amador County Hospital in Jackson, California. I brought in Sutter Health resources to help me manage the laboratory. After I left, Sutter Health leased the hospital from Amador County and subsequently replaced it with a new facility. I reconnected with Sutter Health again while I was managing the Oak Valley District Hospital in Oakdale and hired the organization for managed care contracting and consulting as needed. As part of the contract, hospital managers were able to network with other Sutter Health managers and learn from its best practices.

During ten years as CEO of Oak Valley, I got to know the Sutter Health organization very well and eventually learned about the opening for a CEO at Sutter Tracy Community Hospital. I became part of the Sutter Health organization as CEO of Sutter Tracy in 1997. I left in 2005 to come to Antioch to become head of the Sutter Delta Medical Center.

Continuing my commitment to live and work in the same community, we bought a home in Brentwood. I have no wish to manage health care services as an outsider but to be a member of the community. I wanted to take my place as a local resident so I could learn about the needs of the communities we serve from first hand experience. My wife and I began participating in community events from day one. My attitude about local residency is shared by the culture of our facility as over 90% of Sutter Delta Medical Center employees live in East County.

Management by Walking Around, Listening, and Doing
Some executives have an “untouchable” attitude toward their job, but I’m a hands-on manager. When I joined the hospital I set expectations for myself to become familiar with all aspects of hospital operations. I walk the halls every day and consider that I’m “doing my rounds.” I’m in constant communication with the staff. I don’t like organizational difficulties to go unnoticed and unattended to, and I don’t want staff members being frustrated with their jobs; I encourage them to talk about their issues so we can improve them.

People in my position need to make decisions in a timely manner even if they end up being the wrong ones. Hopefully making the wrong decisions will only happen on rare occasions. I believe in trying something out and if it fails then we fix it or throw it out and try something new. The secret to effective program improvement lies in rapid cycle changes. Find out what isn’t working, provide an organizational fix to whatever process is broken, and then check to see if it is now working.

My attitude toward management is that every one of us in the organization — including all of us who aren’t at a patient’s bedside — are still working for the person in that bed. I try to promote that attitude by making changes in the organization of the hospital to flatten the structure so there are fewer layers of management between the employees “at the bedside” and myself. I’ve lowered response times and we are more efficient about addressing situations as they arise.

I believe in recognizing and ac-knowledging exceptional acts by our hospital team members. Everyone likes to be appreciated so our leadership team takes the time to write thank you notes to staff members who do extraordinary work or go the extra mile.

My goal is to set a climate of continuous organizational improvement that will lead to exceeding the expectations of patients, staff, and physicians. We survey each of these groups to see how we are doing and then develop action plans to make it better.

We make improvements in running the hospital by carefully tracking patients’ and employees’ experiences. We need to encourage evaluations by patients and employees, and then really listen to what those people are saying to us. Our patients are customers of our services who can always go somewhere else for medical care. The same is true of our staff. We want to keep good people employed here at Sutter Delta. We want to become the employer of choice.
We are aided in our evaluations by methods of rating hospitals that compare facilities through a standardized testing system called Hay Surveys for employees and Press Ganey Surveys for patients.

During my final years at Tracy, for example, Hay Surveys revealed that we were in the top quarter in the nation and number one or two in Sutter Health in employee satisfaction. Now our goal is to help Sutter Delta rise to the top of the system in employee satisfaction.

Sutter Health’s overall employee satisfaction last year was in the top 70th percent. In Tracy we were in the 80th percent range and now we’re aiming to bring Sutter Delta up to the 99 percent range. This fall we will be adding a physician satisfaction survey, as well.

Sutter Delta Medial Center is rolling. We settled our labor contract recently after weathering a strike a year ago. We already have a wonderful facility and now we are planning and improving to provide the best care to every patient, every day.

Local residents are increasingly able to get their health services right here in East County. We are working hard to ensure that the medical attention they get here is superior to services available found on the other side of the hill. °