Hospital Staff Baffled by 13-Year CEO’s Abrupt Exit : Health care: Some blame departure of Robert Quist at Los Robles Regional Medical Center on changing corporate nature of medicine.
At Los Robles Regional Medical Center in Thousand Oaks, doctors and staff members are still baffled by the unexpected departure of chief administrator Robert Quist from the hospital’s top office.
Doctors who worked with him describe Quist fondly as a “quality guy,” a strong leader who had been instrumental to the success of east Ventura County’s largest hospital and a consummate professional during 13 years as its top executive.
Why, then, did he suddenly lose his job 10 days ago?
Many in the Ventura County medical community assign the blame to the ever-changing face of health care.
They say that as a representative of the “old guard,” Quist was a victim of the national movement away from the comfortable, traditional doctor-patient health care system.
The removal of Quist is just another example of a system that replaces kindly old Marcus Welbys with those identified by the decidedly unfriendly title of “gatekeeper,” they say.
But, more specifically, they blame the big corporate boss, Columbia / HCA Healthcare Corp.
From the maternity ward to the cafeteria and scrub rooms, there is anxiety and anger at Los Robles. If Quist, practically an institution at the 216-bed hospital since 1982, can be fired, staffers wonder how many others might be vulnerable.
Last week, Columbia / HCA sought to squelch talk that there might be layoffs at the hospital and to smooth over what company officials acknowledge has been an awkward transition period.
“I take full responsibility for that,” said Steve Monaghan, chief operating officer of Columbia / HCA’s Pacific regional division, which oversees the company’s holdings in California. “There was a communication problem. We’re certainly going to try and do everything we can to improve communications between the regional division and the hospital.”
Columbia / HCA is an international corporation based in Louisville, Ky. It owns 195 hospitals in the United States, England and Switzerland. The company was formed in March when Louisville-based Columbia Healthcare Corp. merged with Nashville, Tenn.-based HCA-Hospital Corp. of America, which formerly owned Los Robles. Locally, Columbia / HCA now owns Los Robles and a hospital in West Hills.
According to Columbia / HCA, Quist resigned Nov. 10.
Quist did not respond to requests for an interview. But friends say he has told them that he was fired. And around the Ventura County medical community, no one seems to believe the corporate word on the matter.
“This is a rude awakening for us about big business,” said Larry McAdam, a doctor of internal medicine at Los Robles who has been a friend of Quist’s for years. “I don’t really know what is behind this decision. It baffles me.
“This does not bode well for our local hospital,” he said. “I think the method in which it was handled was unprofessional, precipitous and unwarranted.”
At the very least, McAdam said, Columbia / HCA could have consulted the medical staff at Los Robles. “It caught everyone by surprise. HCA would never have removed him. This tells me that Columbia has a different philosophy, which really disturbs me.”
Many of his colleagues said they believed that Quist, 49, was treated badly by CHCA. They said they worry about him, pointing out that he has children in college and that last year he took out a mortgage on an expensive new home in Westlake Village.
Neurologist Paul Dudley said many of Quist’s colleagues are writing and faxing letters to Columbia / HCA protesting his departure. Monaghan said he had received a few letters.
“The majority consensus is that it was a big loss to the hospital,” Dudley said. “We are all shocked and somewhat concerned. If the new ownership doesn’t see him as a quality guy, we are not sure what their idea of a quality guy is.”
Members of the local medical community see the timing of Quist’s departure as particularly unfortunate. The week of his resignation, Los Robles was in the middle of a review by a joint commission that includes representatives from the state Department of Health Services and California Medical Assn.
On the basis of its review, the joint commission decides whether a hospital will receive full or partial accreditation, a critical part of maintaining a good reputation.
Without the accreditation, hospitals face losing federal reimbursements from Medicare and Medicaid programs, as well as increases in insurance rates and an unwillingness by some insurance companies to send patients there.
“Accreditation shows the community that the hospital is running a good operation and that it runs efficiently and effectively,” said Monty Clark, a regional vice president for the Hospital Council of Southern California.
The three- to four-day process is extensive and expensive, costing even the smallest hospital several thousand dollars, he said.
“It’s not a once-over lightly,” Clark said. “It’s very intense. When you know you’re going to have a joint commission survey, you need the glue to hold the team together. The chief executive officer is the glue that holds the team together.”
Quist left the hospital the day after the joint commission completed its survey. He has told friends that Columbia / HCA wanted him to leave earlier, but that he wanted to be there for the survey.
Although Monaghan declined to discuss the details of Quist’s departure, he said Quist decided when he would leave.
“I did hope to work out a transition period with Mr. Quist,” Monaghan said. “The timing of the departure was his choice. He was offered an alternative.”
Monaghan would not elaborate on what the alternative was.
Los Robles spokeswoman Jill Donahue said initial reports from the survey team indicate that the hospital will receive full accreditation, and possibly even a commendation. She said Quist told staff that he was leaving the hospital at the same time he delivered the good news about the survey.
“It was like, you want the good news or the bad news first,” Donahue said. “He is such a gentlemen. Of course, he was very proud. His words were that this was the best going-away present that we could have given him. He was a class act right down to the end.”
Outside Los Robles, members of the local medical community said they were also dismayed to learn that Quist was leaving.
“I was saddened and surprised,” said Mike Bakst, executive director of Community Memorial Hospital in Ventura. “Bob is one of the main staples of the health care community in Ventura County. He is well-respected and liked. He is viewed as a progressive and dynamic administrator. That hospital was like a home to him.”
But at Los Robles, not everyone shares that opinion. While many of the doctors there say Quist was an effective leader, there are those who say he may have taken too long to adapt to changes in health care. He may have been regarded as somewhat provincial and resistant to managed care, critics suggest, and it may have cost him his job.
Still others speculate that Quist was fired to make room for Ken Underwood, who came from regional headquarters to take over the position of chief operating officer at Los Robles last week, stepping into a job that had been vacant for six months. Underwood will temporarily assume Quist’s duties as well, and some staffers say they think that Monaghan was simply trying to bring in one of his friends.
“That is totally untrue,” Monaghan said. “Before we moved out here four months ago, we had conversations with Mr. Quist about Ken coming. He was in full support of Ken Underwood taking that position. It is simply the No. 2 spot and had nothing to do with Mr. Quist’s departure.”
Underwood was probably moved into the position more quickly than anticipated because of the void left by Quist, Monaghan said.
“As for the part about him being a friend, I have known him for a long time,” Monaghan said. “He has a superb knowledge of health care issues. And he is a friend, yes.”
Some staffers say that Quist was let go as part of a cost-cutting plan and that Columbia / HCA hopes to have administrators at West Hills split their time between the two hospitals instead of replacing him.
“Absolutely incorrect,” Monaghan said. “As we speak, I’m engaged in a CEO search for Los Robles. I already have six outstanding candidates. The two hospitals are totally different markets.”
He said he hopes to have narrowed the field within a few weeks. And whoever the finalists are, he says he will ask physicians at the hospital to evaluate them, soothing the ruffled feathers of those who believed that they should have been consulted about Quist’s sudden departure.
Said Monaghan: “I hope to have a couple for the physicians to speak with, so they can meet them and feel comfortable with them.”
