[W]hat tops the to-do list for the new CEO of New Hampshire’s sole academic medical center and largest private employer?
Dartmouth-Hitchcock chief Joanne Conroy said she worries about having enough people to deliver health care to the region’s aging population. She expects workforce needs will continue to grow through 2025.
“When we look at our projections, it’s going to get worse before it gets better,” Conroy said during a meeting with the Valley News editorial board on Tuesday.
Conroy, who took the helm of Dartmouth-Hitchcock in August, says challenges to the recruitment and retention of employees include a dearth of affordable housing, limited public transportation options and an increased demand on services, particularly from schools.
Addressing the health care needs of an aging population also may require changing the way health care is delivered, Conroy said.
As part of that shift, Conroy said, she has been in talks with the Alice Peck Day Memorial Hospital, an affiliated hospital, about setting up an emergency department specifically geared for geriatric patients.
Dartmouth Hitchcock cannot tackle its workforce issues or the health care needs of an aging population on its own, Conroy said. Addressing them will require collaboration between employers and communities, she said.
As with a public health challenge such as the opioid epidemic, it “can’t be like, ‘Here’s the solution,’ ” Conroy said.
Dartmouth-Hitchcock officials, she said “have to build community coalitions that really want to work on these complex problems.”
Workforce solutions may include building additional housing units on the Dartmouth-Hitchcock property, adding a bus route for workers commuting to Lebanon from southern New Hampshire, shifting some hospital care to home settings, and in some cases, replacing people with technology.
Many employees drive as much as an hour and a half each way to work at Dartmouth-Hitchcock Medical Center, Conroy said. They tell her a lack of affordable housing closer to Lebanon is the key driver.
Morristown Medical Center in Morristown, New Jersey, where Conroy once worked as president and chief operating officer, had 350 housing units located on its property behind the hospital. Some of these units were kept affordable through the Section 8 voucher program funded by the U.S. Department of Housing and Urban Development, she said.
“They were (offering) affordable housing even for people who were not employed there,” she said.
Conroy would look to find partners to help support housing at Dartmouth Hitchcock. “We need partners because we’re not a construction company,” she said, and the hospital needs “to be sure that we’re building something that people actually want.”
Dartmouth Hitchcock currently benefits from a bus route, operated by The Current, that includes a stop at a park and ride in Springfield, Vt. A similar service would help employees commuting from the Manchester area, she said.
In addition to making it easier for people to work at Dartmouth Hitchcock, Conroy said it’s also possible that some tasks those employees now perform, such as vacuuming and scheduling, might be turned over to robots. The employees would perform other work, she said.
While technology may be used for rote labor labor needs, Conroy said, human beings are essential to health care delivery.
“I’m not sure we’ll ever have the supply of health care workers that we need,” she said.
A system of affiliates
Addressing aging patients’ needs may require shifting the location where care is delivered, Conroy said. Instead of providing inpatient care in a hospital, there is a growing demand for home care. That shift would require an increase in the home health care workforce and the number of care coordinators who would be responsible for communicating with hospital clinicians and home care workers, she said.
An emergency department focused on geriatric care at Alice Peck Day would address the needs of older people in a less chaotic setting than a traditional emergency room and draw on Alice Peck Day’s expertise in caring for older adults, Conroy said.
Conroy also wants to improve oncology services for older patients, which is a top priority for both clinical and research appointments, she said.
Another of Conroy’s goal is integrating employees at Dartmouth Hitchcock and its affiliates, including Mt. Ascutney Hospital and Health Center, New London Hospital, and Visiting Nurse and Hospice for Vermont and New Hampshire, into a cohesive system.
As the current affiliates learn to work together effectively, Dartmouth Hitchcock, which has outpatient clinics in Manchester, Nashua and Concord, continues to seek a suitable partner in the southern part of the state, Conroy said. It is too soon for her to speak publicly about any specific discussions, she said.
“We probably will align with a partner,” she said. “Somebody who shares our values (and has a) similar commitment to quality and cost.”
The partnership may be, at least to start, more of a clinical collaboration than a full merger, she said. “I think you should date before you get married,” she said.
