Sally Jeffcoat always knew she would be a caregiver.
"My father was a surgeon. He was my inspiration," she said.
A self-proclaimed Army brat, Jeffcoat moved around a great deal but spent many of her formative years in Texas, receiving her bachelor's and master's degrees in nursing from the University of Texas.
"Hook 'em horns," said Jeffcoat. "But I've been gone from Texas for 10 years now, and my family and I adore Idaho."
In June, Jeffcoat will mark her third anniversary as one of Idaho's highest-profile caregivers: president and CEO of St. Alphonsus Regional Medical Center. Though she spends many of her days in a neverending string of meetings, she sat down long enough to talk about her colleagues, health-care reform and how she still loves to take time to visit with patients.
Do you look at your position dramatically differently than when you first came here?
In 2009, we were in the process of looking at acquiring three hospitals to the west, in Nampa, Ontario, [Ore.], and Baker City, [Ore]. I knew that was a possibility when I came into the position. My first year was very much about creating that new health system. It was great to create something from scratch. Now, we have a family of four hospitals, 900 physicians and a lot of associates.
How many employees are in your system?
About 5,000 associates.
Are you experiencing any staffing shortages for any particular specialties?
It goes in cycles. I think with the economy, a number of people who would not normally be working full-time are holding onto those jobs. So our nursing vacancies aren't as severe as in years past. The areas in greatest need are pharmacy and medical imaging - radiology, ultrasound and MRI technicians.
What is your current operating budget?
Across the four hospitals and medical group, our revenues total close to $700 million. The Boise operation is about $440 million.
Are you expecting more growth?
A little bit. Our volume of patients is modest; maybe it's a 1 percent increase. But we're seeing a big shift from inpatient to outpatient, so our growth is on the ambulatory side. As the population continues to grow older, we see a lot more utilization of our critical-care services.
Won't that eventually level off?
It's going to be a long time. We're certainly going to be adding more critical-care beds. If you're really ill, St. Al's is the place to be. Other systems are good and give great care, but I think having a Level II Trauma Center offers highly skilled delivery of care.
Do you have a sense of how many people walk through your doors?
We impact approximately 300,000 people a year.
Is that a daunting number for you?
I see it as a sacred thing - the opportunity to live our mission, caring with dignity. I get a little philosophical about it at times and I take it quite seriously. I think it's really important to interact with as many people as possible. And part of that is being a faith-based organization. I hope that at least once every day somebody feels that I bring God's presence into the room with me. Even in our business meetings, we start with a reflection, and it's remarkable how that can set our tone. Someone can think, "Oh, that's why I'm here. To bring healing and hope, to further the mission."
And how does that mission relate directly to a patient's care?
Last Sunday, I had noticed one of our nurses had been crying. She told me about a 95-year-old woman, diagnosed with dementia. Her guardian decided that she didn't want to be her guardian anymore. Plus, the patient had been really missing her dog and she was quite emotional. One of our nurses brought the patient one of our St. Al's [plush] bears and told the woman, "You get to name him and take care of him while you're here, until you see your dog." She was so happy and the nurses were so touched. They were trying to get that woman into a better spiritual place. I'm so proud of the people that I'm privileged to work with.
I must note that your eyes are welling up; do you find yourself occasionally emotional?
Every once in a while. I'm very decisive and very clear when I need to be. But the more you can be yourself and disclose what you really care about, that engenders trust and natural passion.
Do you ever take a break from your meetings and go visit the nursery?
It's probably one of the things that I get the most satisfaction out of but have the least time to do. It's one of the most joyful things that takes me back to my roots.
Part of St. Al's mission statement invokes social justice and caring for the poor. Have you seen an increased need for your care from those who may live in the shadows?
Last year, we delivered $37 million in charity and community benefit systems. But there is always much more to do. The downturn of the economy has affected so many people, and so many aren't seeking care because they simply can't afford it. I don't know if we really know what's out there. And by the way, when I think of the poor and vulnerable, it's not just people who are economically poor. You can be poor in spirit as well.
What can you do differently?
We're piloting three patient-centered medical homes and that's very exciting for us.
What do those homes look like?
It's a different model of care: a team of people prepared to care for the individual. We're asking that primary-care physicians serve as team leaders, working with a number of individuals to coordinate the patient's care. In an ideal setting, there would be 2,000-3,000 individuals assigned to a patient-centered medical home.
Where are you with this project?
We just started. We're investing significant resources into the program. One is on Overland Road, another in Eagle and another on Federal Way. Once these are successful, our plan is to roll out similar homes throughout our whole region.
Let's talk about the Affordable Care Act. How anxious are you about the pending ruling from the U.S. Supreme Court?
There are so many different predictions, but it's not affecting our plan. We know that the health-care system is broken. If you look at our nation in a global context, it's easy to conclude that our health-care system is too expensive and doesn't produce the kind of outcomes you would expect if you're investing as much as we do. Our ability to succeed as a nation, with a more stable economy, is going to require that we address our health-care system. We know that we have to change the way we deliver care, and the patient-centered medical home is an example. I quite simply believe that everyone should have access to a fundamental level of care. As a clinician, as a nurse and as somebody who has been in a lot of health-care settings in different communities, I just can't imagine turning somebody away if they're in need.