Notes from the President — One Loma Linda

A decade of progress toward this important destination 

The impact of significant decisions is often realized only when looking back some years later. Loma Linda University Health has had a series of these throughout its history. I want to share a recent one that is now delivering results.

Since its beginning, Loma Linda University Health has sought to balance its various functions. Some of the first board minutes record discussions on whether the organization was to be a college or a hospital. The answer was usually YES, it needed to be both, but that debate has gone back and forth through the years.

Now look back with me just a decade ago — 2008. Barack Obama had just been elected president, the economy was tanking, and a national discussion had started about a whole new healthcare system for the country. In that uncertainty, we were also facing a major decision. Along with many older hospitals in California, we had to construct a new hospital building to meet the state seismic requirements. It was a mandate, not a choice. Like others, we had been given a deadline — December, 2014 — just six short years ahead. Our initial plans to retrofit our current building, opened in 1967, became impractical. We started talking about a new pediatric/maternity hospital west of Loma Linda Academy, but the complications of having a new hospital on the other side of the railroad tracks from our current hospital was too expensive, with many unknowns.

So as the future of government healthcare — through the Affordable Care Act, dealing with Medicare and Medicaid — were being debated in Washington, we were trying to decide where and how to build a new hospital. We examined everything: how much it would cost, where funding would come from, size and scope of the project, services it would offer, new technologies being developed, what healthcare would look like in 20 or 30 years, as well as who would be paying for the many patients we would be expected to care for and at what reimbursement levels.

Quite apart from the challenges of a new building was a parallel set of concerns. How should Loma Linda University Health organize itself for the future? Was our current model, with four separate governing boards, adequate to handle the new realities? How closely should we be tied together — a tree trunk with three major, sometimes competing, branches — the university, the hospitals, and the physician practices? Or should our relationships be different? If something threatened the hospital viability in this uncertain period, could the university or physicians survive on their own?  

In this period of both external and internal uncertainties, we did a lot of soul-searching.  These were big decisions with implications for generations to come. We needed to get it right. It was in that context that the idea of One Loma Linda came up. Rather than separating our entities completely, as many academic health science centers were doing, should we come together more tightly?   

In times like these, I am always encouraged by reviewing our history — the many tough questions that those before us have faced with God’s help. One of my biggest concerns was how we could maintain our mission most effectively. How could we keep an expanded, united entity singularly focused on the teaching and healing ministry of Jesus Christ?    

We use a consensus model of decision-making on this campus, so the idea of One Loma Linda was discussed many times in various forums. One of our biggest concerns was how to get our doctors and hospitals to collaborate more effectively. Typically, in America, they compete for limited funds, but we needed more efficiencies — better quality for less money — to remain competitive.  

Over several years, the momentum gradually built, enthusiasm replaced doubt, and actual plans to make One Loma Linda operative were developed. With that commitment, the decisions about the organization and funding of the new hospital became clearer. Plans were finalized, systems put in place, and a timeline for construction was developed. State deadlines were eventually pushed back, funding was secured, and the building project is now well underway.

I am deeply grateful for all my colleagues who have helped actualize this One Loma Linda strategy, with a shared governing board. Collaboration is at an all-time high across the campus and efficiencies have been realized. A report from the Advisory Board shows that we are now the most cost-effective teaching hospital in California. New student learning opportunities have opened up throughout our system. Finally, a merger into a combined financial system on the same fiscal year, with one audit, has been accomplished. We have truly moved to a shared governance and management model.

So once again, are we a hospital or a university? The answer is still YES, and we intend to stay that way. As the new hospital goes up, our physician groups continue to expand and the university is conducting its research and educational programs. We are keenly aware of the opportunities and responsibilities of being One Loma Linda — together. While the journey is not over, we’re on the right track.

Richard Hart, MD, DrPH
President
Loma Linda University Health

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