In April 2009, Spokane’s Shriners Hospital for Children was on life support.
“Either we close six hospitals now,” announced national Shriners board chairman Ralph Semb, “or we might have to close all 22 in a matter of five to six years.”
The endowment that underwrote the fraternal organization’s free pediatric care had shrunk from $8.5 billion to $5 billion in less than a year, and maintaining the hospitals was costing $1 million a day.
Yet delegates to that year’s national convention rejected closing any facilities.
The endowment gradually rebounded, and the hospitals began accepting insurance and Medicaid.
Last year, Spokane’s Shriners Hospital treated more than 10,000 youngsters, regardless of their ability to pay.
But now the Lower South Hill hospital itself needs treatment. Sometime in the next five years, the 30-bed facility likely will require a major renovation or replacement.
Responsibility for overseeing that transition belongs to Peter Brewer, who assumed leadership of the hospital in 2013.
During a recent interview, Brewer discussed mentors, his previous career, and getting the hospital’s message out.
S-R: Where were you raised?
Brewer: My dad was military, so we moved around. I grew up primarily in the Boston area. My ancestors were New Englanders.
S-R: What was your first job?
Brewer: In eighth grade I started working for an extremely wealthy old gentleman, caring for his elaborate rose gardens and vegetable gardens. I did that every summer until I was a freshman in college. He was a mentor in a lot of ways, teaching me the value of hard work and how to drive a World War II Willys Jeep.
S-R: Did anything you learned gardening transfer to subsequent jobs?
Brewer: Certainly attention to detail, stick-to-itiveness, and thinking outside of the box.
S-R: Where did you attend high school?
Brewer: The Hill School in Pottstown, Pennsylvania.
S-R: Did you have a favorite class?
Brewer: I thought I wanted to be an engineer, so I was heavy into math and sciences. Once in college, I learned real quickly that was not my forte, and eventually earned a degree in history and international relations.
S-R: How about other interests?
Brewer: My father was a flier, so I started flying in high school and got my pilot’s license when I was 19. Wanted to follow in his footsteps, I joined ROTC at Lehigh University, and after graduating went off to pilot training.
S-R: How long were you in the military?
Brewer: Twenty-seven years. After flying a while, I decided that wasn’t how I wanted to spend the rest of my life. So I relinquished my line commission, went back to graduate school and signed up with a reserve unit as a healthcare administrator – a Medical Service Corps officer. My intent was to do that for three years to get experience, but three years led to 27.
S-R: Were you ever deployed?
Brewer: Multiple times – Africa, Albania, Iraq.
S-R: What brought you to the Shriners?
Brewer: Another mentor, Gene Raynaud, who was in this position before moving on to the Honolulu Shriners Hospital, suggested I apply. I had just retired from the military, and wanted another career that got me excited in the morning.
S-R: Had you ever been to Spokane?
Brewer: No. I’d never been to Washington state.
S-R: What was your first impression?
Brewer: My wife, Karen, and I fell in love with Spokane – its size, the community, the schools, and the changing seasons.
S-R: Was the hospital’s future less shaky by then?
Brewer: Yes. The endowment recovered along with the stock market, and in 2010 we became the first Shriner hospital to accept insurance payments.
S-R: What’s your operating budget?
Brewer: Roughly $20 million a year.
S-R: How much of that comes from insurance?
Brewer: We’re very fortunate in Spokane, in that 92 percent of our patients are insured one way or another. That’s the highest percentage in the system, and pays about 60 percent of our costs. The other 40 percent is covered by the endowment, as well as gifts, bequests and funds from the 12 regional temples.
S-R: Are you a Shriner?
Brewer: I am not.
S-R: The organization’s membership has dropped from a peak of 940,000 to 250,000. Can it sustain its hospital system indefinitely?
Brewer: Yes. And overseas membership in the Shriners is going through the roof, particularly in the Philippines.
S-R: How has the system’s business model changed in recent years?
Brewer: Some of the 22 hospitals have dropped to smaller ambulatory surgical centers. That reflects the broader change in health care. When I arrived, 62 percent of all surgeries were outpatient. Now it’s 75 percent, and continues climbing.
S-R: How many beds does your hospital have?
S-R: Are they full?
Brewer: No. Our typical occupancy rate is three to six patients. On a given day, we could have up to 11 patients in beds, but most go home at the end of the day.
S-R: What’s your staff makeup?
Brewer: Roughly 145 full time, and 60 part time.
S-R: How many of those are doctors?
Brewer: We have the only four fellowship-trained pediatric orthopedic surgeons in the region. We also have five pediatric anesthesiologists and two other pediatricians, as well as physical therapists and occupational therapists.
S-R: Are you functioning at 100 percent capacity?
Brewer: Not quite. But in 2013, we were the first hospital in our system to implement an urgent pediatric fracture clinic, and last year we saw a 30 percent increase from the year before in those outpatients.
S-R: Fractures sound like accidents – bike spills and soccer collisions. Do most people think of you as a minor-emergency clinic?
Brewer: No, which is part of our image challenge. When people think of Shriners, they think of crippled children, which used to be part of our name. They don’t think of sports medicine, but they should.
S-R: Can parents bring their injured skateboarders directly here?
Brewer: The first step is to visit an emergency room, because the injury has to be a documented, non-compound fracture. From there they can be referred to us the following day, when the swelling has gone down, and we can evaluate whether they need a cast, surgery or other treatment.
S-R: Are other hospitals likely to refer those injuries to you? After all, patients are money.
Brewer: It’s getting better. We have a very close relationship with Providence, and I’m really impressed with how the other major players are starting to pull together, as far as care for kids goes.
S-R: How do you get your message out?
Brewer: Shriners have traditionally not done a very good job, to be honest. But that’s changing. During the last couple of years, the Shrine has invested heavily in its website and social media advertising. There’s also been a significant increase in TV and radio ads explaining what we’re all about.
S-R: What’s your leadership philosophy?
Brewer: If you go all the way back to my high school yearbook, you’ll see I talked about two things: attitude and teamwork. I learned the importance of attitude and teamwork from my high school football and basketball coaches, who played a major role in defining who I am. I try to surround myself with people with positive attitudes, who embrace goals that are greater than any one individual.
S-R: What do you like most about your job?
Brewer: The kids, and seeing how much better they are when they leave.
S-R: What do you like least?
Brewer: Health care in general is very uncertain today, so it’s hard to position yourself for the future. There are 30 million kids in this country covered by Medicaid, and those dollars ebb and flow depending on who’s in charge.
S-R: As an outsider, what have you brought to this hospital?
Brewer: It’s easy to get pulled into the tactical, day-to-day operation of a hospital. I try to focus on long-term issues that will help us not only survive, but grow. We recently hired a healthcare consulting firm to spend four months analyzing our facility and our needs, and develop a strategic business plan – new service lines, programs, relationships and the facility itself.
S-R: How will the hospital be different in five years?
Brewer: I think we’ll either completely renovate this building or move to a new location.
S-R: Will there be a Shriners hospital in Spokane 10 years from now?
Brewer: No question, there will be.
S-R: During your military career, you oversaw healthcare delivery to mostly adult patients. What’s different about working with youngsters?
Brewer: The difference is I get down on one knee – on their level, talking to them in their terms, and reassuring them we’re here to help.
Writer Michael Guilfoil can be contacted at firstname.lastname@example.org.
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