A Once-in-a-Generation Transformation at an Academic Public Hospital During Federal Funding Uncertainty

Abstract: Fiscal and regulatory pressures on public hospitals and academic medical centers (AMC) will likely worsen in coming years, given looming changes to Medicaid and federal research funding. Recently, such pressures threatened to disrupt the 140-year affiliation between the Los Angeles General Medical Center (LA General) and the University of Southern California (USC). We sought to describe lessons learned during a two-year restructuring of this relationship, and to describe the impact of this transformation on patient care. Hospital-wide mortality metrics were extracted from the Vizient Clinical Database and Leapfrog hospital safety scores were retrieved from public releases. Citing increasing fiscal pressure, in March of 2023, USC noticed LA County that it was terminating the existing $170 million per year medical school affiliation agreement (MSAA) that funded > 90% of the clinical staffing at LA General. In response, LA General began a national hiring campaign to ensure sufficient staffing irrespective of the outcome of ongoing negotiations. In 21 months, LA General hired 273 physicians, dentists, and allied health professionals across all 19 clinical departments. Meantime, LA General and USC evolved a shared understanding that a blended model of employment best served both organizations. Such a dramatic transformation of workforce in such a short period of time raised concerns about risks to patients. We therefore monitored hospital-wide mortality rate and Leapfrog patient safety scores during the hiring process. However, hospital-wide observed and observed/expected mortality rates significantly declined the quarter after hiring began, and Leapfrog safety scores rose during the hiring period. Public hospitals and AMCs can strengthen their relationships despite ongoing fiscal and regulatory pressures via intentional organization restructuring and cultural transformation. Such transformational efforts may be all the more important at a time of great flux and uncertainty in government funding for clinical care and academic research. Keywords: public hospitals, academic medical centers, staffing, culture change, quality improvement, patient safety