Sheltered alongside a quiet hallway, isolated from the early-morning cries of the birthing clinic and the commotion of the emergency room, there is a more subtle freneticism in Deborah Addo’s office. It’s 8 a.m. and the Inova Loudoun CEO’s to-do list is written across most of the white board perched along one of her long office walls. On the boards are lists of people to meet, tasks to complete, places to go. That includes the labyrinth of the hospital itself, which will soon grow to cover more than one million square feet.
In her inaugural month on the job, Addo is still navigating the hallways, learning the staff and trying to find a new home in Loudoun. Her biggest challenge clearly isn’t a commute from her current home in Mt. Vernon or a trip through the hospital. It’s not losing patients to the shiny new StoneSprings Hospital, the Loudoun expansion of Inova rival HCA. Addo says it’s about making a well-respected hospital even better.
“I won’t be satisfied,” Addo said, “with the status quo, ever.”
From Addo’s perspective, Inova Loudoun is undoubtedly strong. Under retiring CEO Pat Walters, the hospital undertook several major expansion projects, received millions in annual donations and garnered the respect of its peers along with the trust of its community. Inova Loudoun now has 1,500 employees, a 183-bed central hospital and several satellite offices in the county, all working within the Inova system, which serves 2 million people in the region annually.
Addo says that past isn’t enough to assure its future. Like a doctor to a patient, she knows what happens when a hospital doesn’t treat itself. As a hospital can go from subpar to excellent, it may be even easier to do the opposite.
That’s something Addo says can’t happen. There are too many lives at risk for anything below perfection. She’s spent her life making sure it doesn’t atrophy.
“I feel like I have the coolest job in the world just because of all the things we get to impact,” Addo said. “We’re there when people take their first breath and we’re there many times when they take their last.”
Her temporary commute aside, Addo’s career has taken her exactly where she always thought she’d be — albeit in a slightly larger office. From childhood she wanted to be either a veterinarian, a dentist or a psychiatrist. Mission trips to Jamaica inspired her, and witnessing the squalid conditions of their health centers that rarely had enough food or clean linens to serve the people motivated her to make sure no one under her watch would ever suffer the same way.
“I won’t be satisfied with the status quo, ever.”
A multisport athlete at McKinley Tech High School in D.C., Addo was named smartest female student by her class mates senior year. Addo was a pre-med major at Georgetown before she said fate (and a love interest) intervened. She would never go to medical school, but Addo was still drawn to hospitals.
“The steps that I’ve taken, the work that I’ve done, has all prepared me for that,” Addo said. “Whether it was in school, whether it was in sports or in a family of three brothers. If that doesn’t toughen you up, then nothing does.”
That led Addo to the Washington County Hospital in western Maryland, where she would become vice president of patient services. In 2010, she oversaw the construction of Meritus Health, the region’s largest health care provider, which included a new hospital building to replace the 100-year old Washington County Hospital. Addo was COO and senior vice president of Meritus Health, which had grown to include 243 beds and 2,500 employees, when she left for Inova in 2014.
Addo served as CEO of Inova Mount Vernon Hospital for three years, taking over a medical center that was nowhere close to the same stature Inova Loudoun is today. When she started, Inova Mount Vernon had a “C” rating from LeapFrog, one of the premier hospital ranking systems. Three years later, the hospital rating climbed to an “A”. Patient experience and satisfaction surveys reflected this trend, as did the hospital’s finances. In three years, Addo turned the hospital’s bottom line from negative $10 million to a positive $4 million.
Addo said the turnaround started with her at the top. She found out what employees and community members wanted from their hospital, then set the vision both groups could follow. The vision was focused on a sense of pride and accomplishment in the hospital, starting with the medical professionals and trickling down to their patients.
“If you talk to those employees now instead of talking three years ago, there’s a difference about how they speak about their organization.” Addo said. “When you’re trying to change an organization it begins from within. When I started to see that change, I knew the organization was on its way.”
Addo can attest to how much further Loudoun is today than Mount Vernon was three years ago. She’s quick to point out that wouldn’t be possible had it not been for the many people who came before her.
“When we’re good we’ll acknowledge that we’re good. When we’re not as good, we’ll do the things we need to in order to get better.”
Inova Loudoun has been part of the system since 2005 but has roots that go back more than a century. Partnerships with the Washington Redskins and Loudoun County Public Schools, volunteer booths at 5K races and community fairs, one of the world’s largest fundraising rummage sales and generations of history mean the hospital isn’t too far from the minds of local’s.
“This is the ultimate example of the community hospital,” Addo said.
Addo says that’s also because of the staff. As she continues to learn about them personally, Addo said she’s impressed with their credentials. Perhaps most important is their longevity, which shows not only talent but satisfaction. Employees seldom leave a position they love.
That same stance applies to Addo. Like an acclaimed coach appointing an assistant as his successor, hiring from within the system shows Inova is satisfied with Loudoun’s success.
That’s not to say Inova is without challenges. Beyond StoneSprings, a two-year-old hospital just a few miles to its south working to earn the reputation its rival has now, Inova Loudoun must be aware of internal threats.
Addo explains that starts with the emergency room, which is many patients’ entry into Inova. While the hospital doesn’t suffer from outsized wait times, Addo said she is not satisfied with the experience for patients that are admitted overnight. She said they spend too long on stretchers before a room opens up.
Alongside the physical limitations of a 183-bed hospital in a county with 375,000 people are omnipresent staffing concerns. While nursing shortages haven’t been a significant problem at Inova Loudoun, it has been a growing concern to medical administrators across the country. New trends in private practices, specialists and medical technologies have given nurses unprecedented career choices.
The hospital also has to be aware of existential threats from pathological diseases. Since the turn of the century, U.S. health systems have had to prepare to fight viral outbreaks of SARS, Swine Flu, Ebola and Zika. The next major health scare is inevitable, and Addo said her hospital must be prepared to both prevent and treat a disease it doesn’t yet know.
The Affordable Care Act, and more so the uncertainty around its future, is already a major concern for health administrators. There are growing concerns over amalgamating insurers and lessening coverage. Aetna, one of the nation’s largest insurers, recently announced it was leaving the Virginia exchanges set up by the ACA, and the House of Representatives passed a major adjustment to the bill last week that many fear will strip millions of their coverage.
At present, Addo said the ACA has been a net positive, as the overall increase in insurance availability means more people are seeking preventative care options. Those simple procedures, like an early cancer screening, can help catch serious diseases earlier on, meaning patients and medical staff are spending less time and resources on costly treatments during advanced stages.
It also means fewer hospital visits, as people are going to doctors for minor aliments instead of clogging up emergency rooms. Addo said in an ideal sense, while the ER remains a safety net, fewer and fewer people should have to use it, freeing up hospital resources and personnel.
To Addo, the biggest concern — and hospital’s main focus — is meeting its community’s needs. Loudoun has been particularly hit hard by the nationwide opiate epidemic and teenage suicide. Addo said addressing this need includes preventive measures like education and outreach to stop someone long before reaching the point of addiction or depression. That includes better tracking pain medication histories and understanding the potency of those drugs.
To identify those problems, and the issues the county will face in the future, Addo said it comes down to listening. In the next few years, the hospital will go through its comprehensive community health needs assessment. In the meantime, its CEO is reviewing comments and letters every day to keep the pulse of those it serves. Good or bad, Addo says she shares these with her staff because, as she says, if “one person wrote it, 20 people are thinking it.”
“When we’re good we’ll acknowledge that we’re good. When we’re not as good, we’ll do the things we need to in order to get better,” Addo said. “We can’t be deterred from our objective by external accolades. When we pull back the layer we need to make sure we too believe that. There’s still work to be done. There is no resting on our laurels.”
Most patients will never meet their hospital’s CEO. But they will meet the doctors the CEO employs, and that experience not only impacts that patient’s opinion of the hospital, but possibly even their life. In these early mornings and late nights, through the maze of hospital corridors or the white boards inside an office removed from the public eye, Addo keeps that critical work churning away from the hospital’s front lines to make it even better. She’s confident patients will soon experience it for themselves.
“Keep your eyes opened,” Addo said. “We’re poised to do much more. The best is yet to come.”