Since 2018, Jill Welton has been a hospital administrator in the Valley region and in Greater Los Angeles.
She relocated from the Bay Area to take the top job at Glendale Memorial Hospital, as the rare nurse to take over as chief executive of a medical center. Welton held that role until mid-2024, when she was promoted to the Southern California market president for Dignity Health, the network that owns Glendale Memorial as well as Northridge Hospital Medical Center.
Welton recently sat down with the Business Journal at Northridge Hospital to discuss her role with Dignity Health and reflect on the various challenges that continue to plague hospitals.
Tell me about your role as the Southern California market president for Dignity Health and what that means for you on any given day.
In Southern California, I have six hospitals. I have four in L.A. County and two in the Inland Empire, San Bernardino. I think a typical day is that there’s not a typical day, which is great. The market (is) complex. There’s a lot going on constantly. So basically, on a daily we really just want to know: how are we taking care of patients in our hospitals? That can be payer meetings; it can be population health meetings, certainly quality safety meetings – but really just checking in on operations and strategy and what we’re doing.
Speaking of the patients, I’m curious about who the main groups of patients are that are being treated in the Valley and how that influences hospital staffing.
We serve a really diverse population in all of our hospitals, really, but the, you know, the biggest thing affecting health care now is the aging population. There’s over 11,000 people who do age into Medicare on a daily basis, so that’s increased over the last four years. That’s over 4 million a year. In looking at that, it’s really about looking at the specialties of our staff, providing culturally competent care, providing linguistically competent care. In Southern California you’ve got a mesh of all different types of patients. It’s what makes it awesome and also complex to take care of all these patients. Our focus really on managing this population moving forward, is looking at our ambulatory strategy and simply put, how do we take care of patients before, during and after?
It’s always been really interesting to me that you’ve been a hospital administrator, and you have a nursing background, and I’m wondering if that’s something we’ll start to see more of in the future.
I don’t know if you will or not. I can tell you that from a personal standpoint, having a clinical background helps. I think it’s a good advantage, because you know what you’re asking people to do. And you know what the complexities of the actual bedside are like. And of course – I’m going to plug for nursing – it’s your one constant for a patient. You’re aware of dynamics with patients and families. You’re aware of what everyone else in the hospital contributes, whether it’s dietary or care coordination or lab or radiology. You’re there to see all of it, so when you want to make operational changes, from a leadership perspective, you know what you’re asking.
Yeah, I imagine it really gives you an edge in anticipating how a patient’s going to react, how your staff is going to react in tailoring that message accordingly.
What are your potential barriers to get to your outcome? Yeah, I think it is an advantage to have a clinical background.
Speaking of that background, I remember in 2020 when you invited me down to Glendale Memorial to cover the very first vaccines being administered for Covid-19. Five years later, do you have any particular reflections on that moment?
In the moment itself, I was very nervous to give my first injection in a very long time as a nurse. But really, it was an honor. It was a privilege. It was hope in that moment. And I think I’m so proud of what the Glendale community did and what Glendale Memorial did for Covid to a person in that building.
Hospitals throughout California, particularly since Covid-19, have struggled with negative net patient revenue issues affecting their operating margins. Some of Dignity Health’s operations showed significant improvement and were back in the positive as far as that goes. And even the ones that remain negative were moving in the right direction. What’s the strategy to being employed there?
I think coming out of Covid was tough. It was really hard – labor costs shot through the roof, inflation with supply chain, construction, anything. It was really a matter, for our hospitals in Southern California, to control what you can. That’s your in-house efficiencies, your throughput, your labor, your overtime, your length of stay – it was all really a focus, and always is, because those are the things that you have control over.
Are there any, not obvious challenges that hospitals are going to have to contend with in the coming years?
I think probably the biggest is our opportunity around employee engagement. That has changed. I think Covid had an impact on that. I think people really re-evaluated – ‘What am I doing? What am I doing at the bedside? Do I want to do this? Do I want to do this at the same schedule? There are also generational changes. And we need to accommodate that. What our team does every day is hard, so we need to acknowledge that wellness is big and top of mind for staff.
Recognizing that, I think additionally, in this day and age in health care, it’s become a little more retail. I don’t know how else to say that. It’s so consumer – they want to know, they want it quick, they want it when they want it. For us accommodating that from enhanced digital platforms, we do use ERAdvisor in our market, which is a digital platform for the emergency department, and it just keeps the patient and their family informed – ‘Here’s what’s next. You just had your labs drawn; here’s when they’re going to be back here.’ I think those are two for us, besides the (Medicaid) cuts that are coming.
How concerned are you about Medicaid reimbursements for Dignity Health hospitals?
Highly concerned. Both on the state and federal level, the reductions in funding, particularly from HR 1 and the tax bill, this could really, really devastate the ability to take care of our patients. There’s Southern California in and of itself, is a high medical market, really complex payer environment, super saturated with hospitals and people. And so those cuts really severely impact low-income patients.
While these cuts are going to affect our Medi-Cal population, a huge impact is that services are going to close. It’s happening already, mainly in maternity, mental health, those programs that are heavily supplemented by the medical funds that we receive, both state and federal. The thing that everyone, I think, needs to realize, that we really need to be able to get out there, is that it doesn’t just affect Medi-Cal patients. If the services are gone, they’re gone for everyone. If the hospital is gone in your community, it’s gone for everyone, regardless of your insurance.
Any planned campus expansions or developments of satellite campuses in the near future?
That’s a good question. This really speaks to and goes back to being able to accommodate what people need and what people expect currently. We’re very committed to meeting the community needs and strategically growing our footprint, and again, more looking on the ambulatory side to complete the continuum of care. I don’t have any specific projects to outline, but I can tell you that that is a huge focus for our markets.
What’s the status of seismic retrofits on Dignity Health campuses in L.A. County?
So, 2020 requirements were related to being able to sustain an 8.2-magnitude earthquake; your 2030 will bring you all the way up. We’re following along. We’ll be submitting our plans for seismic, just like the rest of California. That’s kind of where we ended up.
I imagine this very hospital here was a good guiding light for those retrofits.
Rebuilding Northridge after the earthquake did, of course, provide insight in terms of infrastructure required, to sustain and just sort of instilled the importance of building solid infrastructure and maintaining operational continuity. I think that’s the other thing that we’re completely planning with our seismic retrofit.
