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President & CEO reflects on 25 years of growth, change at PCHC

 

When Merrill Thomas joined PCHC 25 years ago, the organization had fewer than 100 employees, serving 18,000 patients at six sites around Providence. Today, PCHC is home to 600 employees who care for more than 60,000 patients at nine health centers and other locations around Providence. 

 In his initial role as Chief Financial Officer/Chief Operating Officer, Merrill listened to the concerns from staff about the physical condition of our facilities and set about addressing them. There was also an effort to modernize the finance systems, which were outdated and not particularly adept at painting an accurate picture 

 After being named President & CEO in 2001, Merrill led separate surveys of our staff, Board, and community to better understand and prioritize all the issues we were facing. This resulted in the Board completing a strategic plan -- the first one in years – as well as a facility expansion plan. These were the first steps towards us finding a new Fox Point site and a replacement for our Prairie Avenue location.

 In the past 25 years, the changes at PCHC have been enormous, always with a focus on improving both the access to care and the services delivered. Merrill sees the opening of the new Prairie Avenue health center in 2012 as one of the greatest achievements during his tenure, one that took a great leap of faith from the Board of Directors. 

The following is a transcript of a discussion with Merrill about the last quarter century at PCHC.

 


What were some of the first steps you took when you joined PCHC as Chief Financial Officer/Chief Operating Officer?

The staff was very unhappy with the physical condition of the facilities and a variety of unaddressed infrastructure needs. As CFO/COO, I led an effort to address these issues. We were Champlin Foundation grant funding to brick three sites -- Central, Olneyville, and Capitol Hill. Every room was a different color with ancient green carpets so we painted and tiled most of the sites. We rented a site at Prairie Avenue, which leaked when it rained and had rats in the basement. 

We also switched payroll services, as the old one was not filing our taxes, installed a general ledger accounting system, and developed a new chart of accounts so that we could track revenue and grants as well as expenses by site and department. 

When I was named CEO in 2001, the first thing I did was implement separate surveys of our staff, Board, and community to better understand and prioritize all the issues we were facing. This resulted in the Board completing a strategic plan -- the first one they’d done in years – as well as a facility expansion plan. These were the first steps towards us finding a new Fox Point site and a replacement for our Prairie Avenue location. This really drove the first years of my tenure as CEO.

How has the organization changed over the past 25 years? What has remained the same?

It is hard to put into words how different things are today compared to when I started. Things have changed so much. Providers used to work at three or four sites with a morning spent at one location and the afternoon spent elsewhere. Scheduling was a nightmare. The establishment of site-based providers was a controversial one at the time, but it really started us on the path to primary care physicians caring for a panel of patients at a single site. Previously, a provider would arrive at their second site at 1 p.m. and all the patients with appointments that afternoon would also arrive at 1 p.m. There was limited parking and seating; people were eating in the waiting areas when they weren’t fighting over who would be seen next by the doctor. The stacks of medical records on the front desks were so high that you could hardly see the person at the desk. The patient “no show” rate was 50% and we spent more time moving charts from one pile to the next and back on the shelf (or in some providers’ car trunks). It was inefficient and not very patient friendly.

What has remained the same is the commitment of providers and staff to delivering quality health care. There has always been the desire to do more and better for our patients. My job, as I saw it, was to get the resources, space, and new systems to allow us to do just that. The commitment to our patients has always – and will continue to – drive us in all our decision making.

Growth has been a big theme over the last 25 years. Do you see that continuing? 

I was discussing this the other day. I do not remember ever having a “growth” plan stating that we were going to grow by a certain percentage in the next year or five years. Growth has come as we try to meet our patients’ needs. The first challenge was to get more space, and then get more providers to fill the space. The dream of a new facility at Prairie Avenue was the main goal for many years, starting in 2003 with the purchase of the property until we were able to open in 2012.

The addition of new sites and programs has really been about meeting our patients’ needs. Today, we deliver great care in clinical areas that previously necessitated us referring patients out of our system. We had no control over the specialty care they received in many cases. When I joined PCHC, we already had Dental and Asthma/Allergy services but have since added Optometry, Dermatology, Integrated Behavioral Health, Case Management, and Podiatry to name a few. Also, we knew we needed to do something to increase access to dental care for children. I am very proud of our $3 million investment in our new dental space which opened in 2014. This has resulted in an increase of over 5,000 new children now having access to dental care!

More growth is happening this year thanks to our new Atwood health center -- which gave us the capacity for 14,000 more patients -- and our expansion at Capitol Hill. In both cases, this has meant more space and new providers. The sad thing today is, there are not enough practices willing to care for our core group of patients anymore. Small practices are either closing or joining bigger groups; hospitals and health systems are focused on merging, rather than delivering primary care to underserved populations. I hope PCHC can continue to fill that need and be the medical home for everyone in Providence who needs primary care. 

Any specific moments that stand out over your PCHC career?

My second interview at PCHC (then called Providence Ambulatory Health Care Foundation) was something I will never forget. It was with a group of about 15 employees from every level of the organization. People were angry and loud and combative in stating all the issues; it was so hostile that I almost felt that the HR team was setting me up! But I knew what we could do, and hopefully shared enough of a vision to show that issues would be addressed. I was offered the job, and I don’t remember if that group approved of it or not, but I accepted, and we started the process of change. 

The other biggest moment was when the Board approved the building of the new Prairie Avenue health center. It was not easy; we were taking on a big risk, and the Board was very nervous. It came down to the final vote, and it really could have gone either way. There were a lot of sleepless nights in that whole process. Who had ever planned a $45 million dollar project in South Providence before, and then made it happen? No one else had, but the PCHC Board knew we needed the space. That grand opening in July 2012 was the start of the next wave of great things for PCHC.

What goals do you still want to achieve?

We have three facility projects that we need to complete:  a new or expanded Central health center, a new Adult Dental site, and a new site for the program for homeless patients. We are working on all three. I do not have an exact date for any of them, but Adult Dental will be in 2023 for sure. 

 Another goal is that we can answer the phone every day with a positive response for every new patient wishing to make PCHC their medical home. Today, we are turning away over 50 calls a day because we do not have capacity. My hope is that one day PCHC will be able to say yes to everyone who wants to come here.

Next year, the Board will begin work on our next 3-5 year Strategic Plan. I am excited to work with them on planning for the coming years to strategize and see how PCHC will continue to meet our patients’ needs through access to high quality care. At the same time, I would love to see us continue to be recognized as a “Best Place to Work” for our staff, who are the biggest reason we can make all these wonderful things happen every day.

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