First of two parts

COAL TOWNSHIP - Geisinger Health System (GHS) will have invested nearly $10 million into its coal region campus by the close of the fiscal year in June.

But the giving goes both ways in terms of what Shamokin Area Community Hospital (SACH) has meant to GHS since the institutions merged in January 2012, says Tom Sokola, chief administrative officer (CAO) for Geisinger Medical Center.

Even more than expected, he said Geisinger has found SACH to be a well-run operation.

"I think we've got a real gem of an addition to the Geisinger Health System," Sokola said Wednesday during an editorial board session with The News-Item to discuss the first year of Geisinger-Shamokin Area Community Hospital. "And I mean that not (just) for the facility, but the people, the independent physicians, the commitment to quality, the commitment to change."

There is little doubt, however, that SACH wasn't going to be able to make those changes on its own. It's estimated Geisinger's investment in the local campus in 18 months is more than triple what the former hospital could have invested over that same time span.

Tom Harlow, former president and chief executive officer of SACH and now CAO of the G-SACH campus, said he formerly worked with an annual capital budget of between $2 million and $3 million. In the years before the merger, that figure was shrinking.

"We were investing less on an annual basis," Harlow said. "Even though we were still profitable, when you see your margins shrink, you have less dollars to reinvest."

Reinvestments have accelerated since the 2012 merger that brought SACH under the Geisinger label, and it has improved patient care, Harlow said. He pointed out one area, patient falls, and how there hasn't been one yet this year in the inpatient geriatric psychiatry unit thanks to efforts by the Geisinger Quality Institute team. Zero falls over nearly three months, he said, was "almost unheard of" in years past.

Formal talks for the Geisinger-Shamokin merger began in 2009 and the merger was announced in November 2010. It was approved by the state in July 2011 and became official on Jan. 1, 2012.

New equipment, employees

Some upgrades at G-SACH were as necessary as they were unglamorous. A new boiler for the heating system was installed, along with redundant cooling and heating systems for emergencies. Also, new patient monitors were purchased for all bedsides.

Technological investments include a new pharmaceutical management system, a telemedicine video conference system and computer hardware and software to add patient information to Geisinger's electronic health records system.

The Ressler Center on the G-SACH campus is under renovation. The building itself is expanding, and with it will come additional services from a new ophthalmology clinic and an after-hours urgent care clinic.

There are 404 employees now working at G-SACH, up 50 from January 2012 when Geisinger took over, according to hospital officials.

Morale down, up

The changes that came with the merger were challenging for employees long used to operations under a different regime. Harlow readily admitted it impacted morale.

"I'd be kidding you if I said it didn't," he said.

"If you talk to the employees, they went through a very difficult time period learning all these new systems at once," Sokola said about the transition.

From a systems standpoint, the transition - having to wait for the Jan. 1 date, with no chance to ease into it lest state regulations be violated - became known on the campus as the "big bang."

One nurse told Harlow how, early in the process, she went home in tears on many occasions while she and others faced the daunting task of learning the new systems and assimilating to the Geisinger way. She pushed through it, as did others. More than a year later, Harlow said, morale is up - and that same nurse who went home in tears recently told Harlow how much things have improved. Employees have become more comfortable with new hospital operations, he said.

"I think that's really a testimony to the staff here," he said.

"And the physicians," Sokola added.

ER numbers 'unprecedented'

Communication between hospital staff and physicians and the administration has improved, too, Sokola said. It was that communication that led to changes in G-SACH's Emergency Department.

According to Geisinger, the emergency room is treating an average of 6.4 more patients daily since the merger. Nearly 20,000 visits are expected this fiscal year, up from 18,224 in fiscal 2012. Harlow called this year's anticipated totals "unprecedented territory."

An increase in patients, however, had led to more waiting. On average, patients waited 30 minutes in July 2012 from the time they were admitted to a room until the time they spoke with a health provider. That doesn't count any time spent in the waiting room.

Hospital staff and physicians aired their concerns about wait times. That led to additional physician assistants and nursing practitioners being hired last fall to work strictly in the ER during the peak times of 11 a.m. to 11 p.m.

Patient wait times have been reduced by 10 minutes, or 33 percent, as measured in February.

Admissions through the Emergency Department are also rising at G-SACH. In fiscal year 2011-12, the ED admitted 2,202 patients. It is projected that number will be 2,325 by the end of this fiscal year.

'Great transition'

Sokola and Harlow had attended a monthly clinical advisory committee meeting with physicians prior to Wednesday's interview. Whether it's ED wait times or other concerns, "if there are issues, they come out and we address them," Sokola said.

He said that's not as simple as it sounds considering the two different cultures that GMC and SACH brought together, one more an academic campus, the other a community-based hospital. But it is working, Sokola believes.

"The family of physicians, the leadership, the board," he said, "it's just been a great transition."