By Dick Broom
Let’s say you need to have a colonoscopy
to check for early signs
of colon cancer. Which hospital
would you choose?
What about gall bladder surgery or a mammogram?
People generally go to the hospital that is closest to
where they live. Or they choose the one they have been to before or one they have heard good things about from family or friends.
Those are often perfectly good reasons for going to
a particular hospital. But sometimes your choices are
limited by what you need to have done, and there may
be other considerations, too.
The factor that trumps everything else is capability—what a hospital is able to do for you. For example,
most community hospitals don’t offer heart surgery, so
if that’s what you need, you obviously need to go somewhere
else. On the other hand, if you need something
that your local hospital routinely handles, there may be
no need to go any farther.
Kerry Hensley, president of FirstHealth Montgomery Memorial Hospital in Troy, says small community hospitals such as hers can meet many of the health care needs of the people in Montgomery County.
“We can do nearly all of the basic surgical procedures and even some of the more complicated procedures right here,” she says. “But if you have two or three complicating health factors such as diabetes, high blood pressure or heart disease, your doctor might want you to go to a larger hospital because of the possibility that you might need intensive care after surgery.”
John Jackson, president of FirstHealth Richmond
Memorial Hospital in Rockingham, agrees that you
don’t need to go to the trouble of traveling to a larger
hospital if your local hospital can take care of you just
“Our physicians and staff are expert at treating all of
the most common medical conditions, as well as some
that aren’t so common, and performing a wide range of
surgeries,” Jackson says.
For example, Richmond Memorial offers orthopaedic
surgery including total joint replacements, which is something
that many community hospitals are not equipped
to handle. Other specialized services at Richmond
Memorial include vascular surgery, gastroenterology,
cardiology, cardiac catheterization and angiography. The
hospital also has a state-of-the-art Women’s Imaging
“Diagnostic testing, delivering babies, and doing gallbladder
surgery and appendectomies are things we do
every day and night,” Jackson says. “I think we do a lot
of those things at least as well as the larger institutions.”
Size is relative, of course. Compared to the hospitals in Rockingham and Troy, FirstHealth
Moore Regional Hospital in Pinehurst
is one of those “larger institutions.” But
it is small and downright homey compared
to the big teaching hospitals in
Chapel Hill, Durham or Charlotte.
Community vs. teaching hospital
If you need a kidney transplant or
certain other highly specialized treatments
such as burn care, a place like
UNC Hospitals, Duke University
Hospital or Carolinas Medical Center
is where you need to be. But for heart
bypass surgery, joint replacement, cancer
treatment and just about anything
else, you can go to Moore Regional.
Robotic surgery at Moore Regional Hospital
“I think the primary advantage of a good community or regional hospital versus a big teaching hospital is that your care is generally much more personal,” says George Bussey, M.D., chief medical officer for FirstHealth. “Here at our hospitals, you know who your doctor is and that he or she is the one who is actually going to be taking care of you.
“At a teaching institution, there is a whole hierarchy of interns, residents, fellows and junior attendings, and even medical students coming through. The doctor who is leading the team might be somebody you never actually see. In that type of setting, it’s easier to de-personalize the whole process of care.”
The difference in the way patients feel they are treated at community hospitals and teaching hospitals might be subtle, Dr. Bussey says, but it is something to consider when deciding where to go for treatment.
“Many times, I think, the physicians
and the entire patient care staff at community
hospitals have even more of an
interest in doing the right thing and
making sure people are satisfied with
their care,” he says. “I think the people
at our three hospitals have a pretty high
sense of pride in what they do and feel
very protective of their patients.”
Jackson agrees that the culture of a
hospital can make a big difference in
how satisfied patients are with their
care and whether they would choose to come back.
“The healing process isn’t just the clinical
treatment; it’s the spiritual and emotional
aspects of it, too,” he says. “If you feel comfortable
that the hospital staff is going to look
out for your personal needs and your family’s
needs, you are likely to have a more positive
attitude and, overall, a better experience.”
The most important factor in choosing a hospital, of course, is whether the doctors and staff have expertise in providing the services you need. An example: At Montgomery Memorial, Dennis Devereux, M.D., has more than 30 years of experience in general surgery. Surgical treatment for breast cancer,
colon cancer and other malignancies are among his areas of specialization. Before establishing his practice in Troy and joining the medical staff at Montgomery Memorial last fall, Dr. Devereux was director of surgical oncology at the St. Francis Hospital Cancer Center in Poughkeepsie, N.Y.
One indication of competence is whether a physician is board certified in a particular medical or surgical specialty. Moore Regional requires that each member of its medical staff be board certified or earn certification within a certain period of time after becoming board eligible.
General surgery with Dennis Devereux, M.D., at Montgomery Memorial
If you want to know about a particular
hospital’s capabilities, its Web site might be
a good place to start. You can learn about all
the services the hospital offers, as well as any
awards or special recognition it has received
for excellence in a particular area such as heart
or cancer care.
For two years in a row, Moore Regional
was honored as one of the nation’s top
100 hospitals for cardiovascular care. Last
year, the hospital was named a National
Quality Leader in heart bypass surgery by
CareScience, a company that helps hospitals
improve patient care quality while
increasing efficiency and reducing costs.
Also in 2006, the Bariatric Center at
Moore Regional was named a Bariatric
Surgery Center of Excellence by the
American Society for Bariatric Surgery.
Bariatric surgery is a treatment option
for some people who are extremely overweight.
Moore Regional’s joint replacement
program is one of the largest in the state
and one of the most successful in the
country. The hospital’s Cancer Center,
first designated as a Community Hospital
Comprehensive Cancer Center in 2002,
has received “approval with commendation” from the Commission on Cancer of
the American College of Surgeons.
Women & Children’s Services at
Richmond Memorial Hospital
|Last year, Richmond Memorial received awards for patient satisfaction in two patient care areas. Press Ganey, a company that helps hospitals nationwide measure and improve their performance, cited the hospital as “most improved” in both inpatient and emergency care among hospitals in its size category. In all three areas of service that Press Ganey evaluated—inpatient, outpatient and emergency care—Richmond Memorial scored among the top 1 percent of all hospitals surveyed in terms of patient satisfaction.
An important consideration in deciding where to go for a particular test or procedure is whether a hospital has up-to-date or cutting-edge technology. For example, Richmond Memorial is one of only a few community hospitals in the state with a computer-aided detection (CAD) system for reading mammographies. A recent study found that radiologists using a CAD system were more effective in detecting early-stage breast cancers.
“FirstHealth has always been committed
to staying at the forefront of where
technology is going,” Jackson says. “So,
as part of FirstHealth, we are able to offer
diagnostic testing and other procedures
that are more advanced than you find in
most community hospitals.”
Hensley says convenience is important
for hospital patients and for their families
and friends. But she says people in
Montgomery County shouldn’t choose
Montgomery Memorial just because it’s
“You should choose us,” she says,
“because you have confidence that we will
take good care of you.”
Nothing can fill a hospital administrator with
excitement and anxiety faster than these five words:
“The Joint Commission is coming!”
Excitement because a visit by a Joint Commission
survey team is an opportunity to show how well the
hospital measures up against national standards for
quality in virtually every area of operation.
Anxiety because, no matter how good a hospital
is, the survey team nearly always finds something
that could be improved.
The Joint Commission (TJC) is an independent
body that evaluates and accredits about 15,000
health care facilities and programs across the country.
TJC accreditation is regarded in the health care industry
as an almost indispensable stamp of approval. It
signifies that a hospital or other health care facility
has met widely accepted standards for quality and
safety in patient care.
To maintain accreditation, a hospital has to
undergo a thorough inspection by a TJC inspection
team at least every three years.
Hospitals usually have at least a few days’ notice
before a survey team arrives, but occasionally a team
will show up unannounced. Following the survey,
which usually takes a couple of days, the hospital receives
a report that points out areas in which it excels
and areas in which it is not as strong as it might be.
“The survey team nearly always finds some area
where you can improve, and that’s good because
we want to know how we can be better,” says John
Jackson, president of FirstHealth Richmond Memorial
Hospital in Rockingham. “A Joint Commission survey
is always a good learning experience.”
TJC used to rate hospitals and award different
levels of accreditation based on their survey results.
That injected the element of competition into the
process, with hospitals trying to outscore each other.
Jackson says he is glad the rating system has been
“I think some hospitals started worrying too much
about getting a high score rather than inviting the
survey team in to really look at everything and identify
areas where they could improve,” he says. “It’s
always good to have another set of eyes looking at
you objectively to see where there might be a weakness.
It helps make us better.”
Most hospitals are TJC accredited, as are the three
FirstHealth hospitals, so accreditation is rarely a factor
in helping people decide which hospital in their
area is best for them. But George Bussey, M.D., chief
medical officer for FirstHealth, says that while some
hospitals might see TJC standards as the ultimate
benchmarks for quality, the three FirstHealth hospitals
see them more as a baseline.
“We are always looking to go beyond that,”