As she enters the end of her second year as CEO and president of JPS Health Network, Dr. Karen Duncan reflects on her experience leading the hospital district. She also discusses JPS’ master facility plan and its plan to attract physicians, nurses and other health care personnel.
JPS Health Network quick fact:
- Number of beds at John Peter Smith Hospital: 582
Note: This interview is from Oct. 25. It has been edited for clarity, grammar and length.
David Moreno: Dr. Duncan, thanks for meeting with me. Before we dive into specific questions, I’m very curious about one thing. Last time you spoke with the Fort Worth Report you had just started as president and CEO. As you end your second year, what has it been like since you took over the roles?
Dr. Karen Duncan: It’s been a whirlwind. I’ll be honest with you. I think any new role that you take on you’re spending your first couple of years just understanding what the work is and the environment in which you have to work. During this two-year period, we have had a change in our Commissioners Court and a change in our board, which makes the environment very different from when I started six years ago in a different capacity here at JPS. When you’re a public entity, you also have to understand that you become part of that political realm.
For me, it’s been more about how do we continue to do our business of health care, and how do we do it in a way in which we navigate not only on the county level, but on the state level, on the federal level, because we really truly did depend on revenue sources that are different than your for-profit hospitals.
Moreno: Speaking of business, let’s talk about the master facility plan. It’s changed with inflation from the original $800 million bond package that was planned. At a previous board meeting, one of the members mentioned there’s been some changes with reprioritization. Walk me through what the master facility plan looks like now.
Duncan: The $800 million bond was never set up to pay for all of the needs of the county. It was to support and supplement the costs of what was recommended.
We had promised that we would save out of our operations an additional $400 million to make that a $1.2 billion package. At that time, $1.2 billion probably would have covered a lot of what those needs are but then COVID hits. It delays the whole supply chain and everything else. In some ways it was probably a blessing. Had we started all that construction, it would have just stood still, and we’d have to pay all these very high costs.
As we regrouped coming out of the COVID surges, we looked at the financial status and felt that we could add an additional $400 million and come up with a $1.5 billion bond that we felt was a good amount to begin with. As we looked at priorities, we knew (addressing) the behavioral health crisis was the most needed, so the psychiatric emergency center became very primary as part of that master facility plan. There was also a need to take more care to an outpatient setting, and so the medical office building was put into that. It will move some of our surgery out of the hospital. Looking at the community, we looked at where we could provide additional access, and the southwest region came up as a high need.
Moreno: As you continue constructing all these new facilities, what is the hospital district’s plan to attract and retain staff with national shortages of physicians and nurses? How do you attract people to Fort Worth?
Duncan: We will have challenges, though we’d probably have challenges for about five years, with either individuals not entering the field, for whatever reason, to be a physician and a health care provider. But also, we have a lot of excellent individuals. We have got to look at how we deliver health care at the employee level that looks a little different than (what) we currently do. So there’s new kinds of health care positions that don’t require the same kind of high skill that we see with nurses, or even with physicians, in order to provide that same level of care.
We do have to compete with salaries. We do market analysis like everyone else does, because we understand that. We do a lot of communication with staff and town halls. We probably have not expanded into the Gen Z or the millennials, who wish to have more of a hybrid, but we are listening to our employees and figuring out what they need and what this needs to look like for patients.
Moreno: Are there any other challenges JPS is having to navigate?
Duncan: There’s so much more demand than there is access with the disparities in care. Those disparities between those who have and those who do not have care are going to be even more if we don’t take care of the more vulnerable population that have health care needs. It will create additional costs for everyone. How do we do it and how do we do it with less money? How do we do it with over half of our budget being uncertain? Whether it’s property tax, whether it’s federal or state money that comes in?
Moreno: A lot of people look at 76104, which has the lowest life expectancy in the state, and yet JPS and the Medical District are in the zip code. I have to ask, how do you look at that and answer when people ask why this is happening?
Duncan: I’ve had that conversation with other CEOs, too, that 76104 sits right in our backyard. I don’t think we have good data as to where we are with 76104. The initial article that was written about 76104, I’m not sure there’s been real follow up to say whether access to health care has increased and actually created some outcomes. But with that said, as long as that narrative’s out there, we’ve got to figure out how we, as a Medical District, come together to really understand what the needs are in there and then begin to meet those needs, but also create the outcomes that we can speak about.
Where the needs are, to your point. Is there a grocery store? We have seven health care sites within 2.5 miles to 76104 for the community to access. The question is why are they not accessing that health care? Is it education they’re not aware of? Or is it that there’s no trust in health care? How do we begin to build that trust?
How do we now get the community and partners to come in and say you’re also responsible for 76104? You’re asking the Medical District but it’s bigger than just the Medical District in changing the outcomes of that community.
Moreno: That’s all the questions I had Dr. Duncan, so thank you. Anything else you would like to mention?
Duncan: I think it’s so important for the community to be at the table. What kind of conversations do we need to have to impact in a positive way?
David Moreno is the health reporter at the Fort Worth Report. Contact him at david.moreno@fortworthreport.org or via Twitter.
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