"My challenge now is to live up to what I've said I'm going to do," Erwin says. "I expect the physicians and employees to test me. I'd be disappointed if they didn't."
They'll see if he really makes a priority of good relationships with doctors and staff workers. They'll figure out if he sincerely means, "I want people to feel they can come up to me and talk about anything." They'll determine if it's actually possible to raise quality while reducing costs, as Erwin maintains.
He'll try to do all that at a hospital that in recent months has fought off an aggressive union challenge, reopened the old scab of Dr. James Burt's liability cases with millions of dollars in lawsuit settlements and seen key specialists commit to investing in free-standing facilities for orthopedic surgery and heart care, two of Franciscan's proudest programs. Like all hospital administrators, he is navigating the sudden storm of health-care changes that have brought decreases in both patient volume and the prices those patients pay.
Erwin, 49, won't concede Franciscan had more problems than other hospitals when he was appointed interim CEO after James Strieby's abrupt resignation Sept. 29. But he does acknowledge that Franciscan wouldn't have been the first local target of the Service Employees International Union if the employees and management had gotten along swimmingly.
He understands the nurses' frustrations. Most patients leave hospitals more quickly these days, he says, meaning the ones who stay are more seriously ill and require more attention from fewer nurses. The nurses themselves didn't put it any more bluntly during the union campaign.
`They see they have to work harder,' Erwin says, `and they wonder why are we constantly looking at the bottom line? They see us looking at costs, and they ask, what about the mission?'
Erwin rarely talks for long about Franciscan without bringing up its mission. It describes `continuing the healing ministry of Jesus' in `an atmosphere of joy, mutual respect and compassion to find better ways of serving.'
`Reducing costs and the mission,' he says, `are not mutually exclusive.'
They can't be, he says. Erwin spent much of his career at Blue Cross Blue Shield, and he knows insurance companies are serious about making roadside waste of hospitals that don't squeeze costs. `We have to be financially sound,' he says. `I make no apologies for that.'
They have to keep finding solutions like the new protocol for pneumonia patients, he says. Franciscan now gives them antibiotics immediately in the emergency room instead of waiting a few hours until they're admitted, and those patients are leaving the hospital sooner. That's only one way, says Erwin, that a hospital can give better care at lower cost.
But even that kind of creativity can't bridge the perception gap in staffing levels, which Erwin calls `appropriate' and some nurses call dangerous.
Much as they appreciate the recent nurses' raise of up to 3 percent, some say they would rather have more people helping them. They talk about losing close to half the recovery room staff in a few months, about positions in many departments that seem to disappear when nurses leave them.
`It's a major, major problem,' says Lisa Spatz, a nurse who supported the union. `I anticipate it's going to get worse as the weather gets colder and more people get sick.'
The number of health-care professionals at Franciscan dropped by 25 percent from 1994 through '96, according to annual reports filed with the Ohio Department of Health. Every hospital is cutting staff, says Erwin, because insurance companies are cutting the length of virtually every hospital stay.
`People need to know what we're doing and why we're doing it,' he says, and that was a big reason he met with all departments so quickly. The more he explains himself, he is sure, the more the employees will understand how he's not sacrificing mission for the bottom line. He'll have those meetings every quarter, he says, and he'll work different shifts so he'll be available to night-shift workers.
`Just fundamental communication,' Erwin says. `I cannot expect people in this organization to support where the Franciscan system is headed if they don't understand what the organization's strategy is and what it's doing.'
He has no illusions that patients choose hospitals out of corporate loyalty. They go where people treat them well, he says. Happy nurses and doctors are good for business then. `You can't survive in this environment if you don't have good employee relations,' he says.
Erwin came to Dayton with a reputation for expanding the Franciscan system's free-standing satellite facilities and lowering costs as administration vice president for the system's Cincinnati hospitals, but his background as a communicator runs deep. A lawyer by training, he was marketing vice president for Blue Cross Blue Shield and then Good Samaritan Hospital for two years before moving to the Franciscan chain in 1989.
He's still meeting with Franciscan physicians to find out how he can better accommodate their needs. If that means giving them opportunities for the investment partnerships that other companies have started offering in free-standing specialty facilities, he doesn't rule that out. `I want physicians to come to this hospital because they want to come here,' Erwin says, `because they know this is where their patients are going to get good care.'
* CONTACT Kevin Lamb at 225-2129 or by e-mail at kevin_lamb@coxohio.com
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Erwin at a glance
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* WHO: Duane L. Erwin, 49, interim CEO of Franciscan Medical Center-Dayton Campus, as of Sept. 29.
* EDUCATION: Undergraduate degree in English from Kent State University; juris doctor degree from Duquesne University School of Law.
* PROFESSIONAL: 10 years at Blue Cross Blue Shield as general counsel and marketing vice president; two years as marketing vice president at Good Samaritan Hospital; vice president of planning and marketing at Lancaster (Pa.) General Hospital; with Franciscan Health System of the Ohio Valley since 1989, most recently as vice president of administration for the system's two Cincinnati hospitals.
* PERSONAL: Wife, Margaret, and three children, all teen-agers. Father, a surgeon, founded Allentown, (Pa.) Osteopathic Hospital in his hometown.
PHOTO: TY GREENLEES DAYTON DAILY NEWS
New Franciscan Medical Center interim CEO Duane Erwin pauses in
his office, where he describes the hospital's mission as `continuing
the healing ministry of Jesus.'