David O’Brien, Market CEO, Kindred Hospitals of South Florida

In an interview with Invest:, David O’Brien, Market CEO of Kindred Hospitals of South Florida, explained how Kindred Hospital The Palm Beaches in Riviera Beach and the three other Kindred long-term acute care hospitals under his oversight have responded strategically to a dynamic healthcare landscape, highlighting the impact of regional growth, quality initiatives, and workforce challenges. “We are a team that really puts the patient at the center of everything we do,” said O’Brien.

What changes have impacted Kindred Hospitals of South Florida the most over the last year, and in what ways? 

The healthcare environment in Palm Beach and in South Florida is constantly evolving. We have seen tremendous population growth and an aging population, which has lent itself to short-term acute care hospitals expanding into new markets. From Kindred’s standpoint, our primary referral sources are the short-term acute care hospitals in the market. We take patients typically that are in their intensive care units (ICUs). As they have evolved to meet the challenges of a growing and aging population, we have made adjustments as well. Our long-term acute care specialty hospitals are licensed the same as them, so we are facing some of the same financial and economic headwinds. Kindred specifically has put a big emphasis on quality improvements. Our parent company, ScionHealth,  (NQS), in 2023 as a nationwide project. In South Florida, three of the four hospitals that I manage are in the Top 10 in the country for quality improvements. We measure infections as our predominant quality indicator, but there are several other quality indicators that we look at like ventilator liberation rate and discharge-to-home rates. I am proud to say that the project has led to tremendous increases in the quality we offer not only to the community but also to our short-term acute care hospital partners. They are making referrals to us based on our ability to help their patients get better. We are very proud of the work that we did in the past year.

What makes Palm Beach County an ideal hub for healthcare, and why is it an attractive region for healthcare providers to establish their practice and services?

It is no secret that Palm Beach County, especially in the northern part, is growing rapidly. We have seen several national health systems opening up hospitals and constructing brand-new buildings in our market. Even some of the long-term players have expanded into the northern part of the county and southern Martin County because people are leaving other states up north. We have become a destination. It used to be that people would just come to Florida to retire, and that is not the case anymore. People with young families are coming. I think the education system has upped the ante for allowing young families to bring children here. For a physician looking to establish a practice, Palm Beach County represents a booming economy. Real estate is strong, as is our economy. I think we have a very successful government structure in place right now that is lending itself to strong economic growth.

Healthcare provides opportunity. We see a tremendous growth in orthopedic surgeries, which are related to younger people that are active in sports. With the population growth, you are seeing an increase in the need for healthcare services. People look for that when they are looking to move someplace. Quite often, one of the most important things they are looking at is the healthcare in the market. It is education for children, but it is healthcare for the whole family. The Palm Beach market is ripe for that type of growth with the population boom that we are seeing post-COVID.

What programs and initiatives are you implementing to build a strong healthcare labor force?

I believe we have been discussing a nursing shortage for what seems like my entire career. As a nurse, I acknowledge that the nursing shortage is indeed real. I consider the larger challenge we face in South Florida to be our turnover rate, which tends to be higher than the national average. In certain communities, Palm Beach specifically, our turnover rate is higher than that of our Miami hospitals. Some of the initiatives we are implementing include an international program. We are hiring nurses internationally and bringing them on board with contracts that ensure longevity. We do offer sign-on bonuses to attract new talent. In four hospitals under my management – Kindred Hospital The Palm Beaches, Kindred Hospital South Florida – Coral Gables, Kindred Hospital South Florida – Hollywood and Kindred Hospital South Florida – Fort Lauderdale – we have gone through a very aggressive Just Culture training program for all leaders, which is meant to create an environment where employees feel empowered and safe to help address challenges in the workforce. That program is built entirely around employee retention to keep our workforce highly engaged. Furthermore, I believe the entire workforce changed post-COVID. A large portion of our workforce was permitted to work from home, and we had to bring them back. We are dealing with staffing shortages and want to avoid burnout. We do everything possible to help people. We have employee engagement committees and try to bring fun to the workplace. It is also important to understand some of the generational shifts we have seen in the workforce. Communication styles are different; some people prefer texts, some prefer phone calls, and some prefer emails. I believe it is important that as an industry and as leaders, we identify the generational shifts we are seeing in our workforce and ensure we are accommodating everybody, whether they are new or have been with us for a long time. It has definitely created some additional challenges for us.

Have you noticed a shift in patient expectations in recent years? 

I think whether we go to a restaurant or a hospital, everybody expects everything to be perfect all the time. In healthcare, we should strive for perfection, but sometimes it is a challenge. We have patient dynamics, patient condition, and family dynamics. The family dynamics play such a huge role because you might have different family members that have different values and a different set of goals for an aging parent, for example. We are supporting people at the most vulnerable time in their life. Being a nurse and a caregiver, I pride myself on leading a team that really puts the patient at the center of everything we do, with the hopes that we are going to have the best outcomes possible. Quite frankly, we could have the best healthcare outcomes for people and still fail them miserably when it comes to their social and personal needs, only because that is a challenge as everybody has a different need and a different want. The same way we have seen that shift with our employees, we are seeing that shift with our patients as well.

What are your thoughts on the rising costs of healthcare? 

The rising cost of healthcare has gotten exponentially worse post-COVID. The price of everything went up, and we have not seen costs come back down yet. That, combined with a decrease in the reimbursement rates that we see, is creating a challenge for almost every healthcare system in the country. I think we are at a point where managed care is the leading force in healthcare reimbursement today in a highly regulated environment. With factors such as lower reimbursements and higher costs, it is becoming a challenge for most healthcare systems to operate at a profit today, which is why you see consolidation in the market where standalone hospitals do not exist anymore as everybody is joining a system to get the added benefits and security.

Again, I believe you have to be committed to what you are doing. You have to want to be a leader in not only healthcare but the patient experience. I think high-quality outcomes today are reported every day by each patient at our buildings. So, while costs are up and reimbursement is down, the expectation is higher than it has ever been. Successful leaders today wake up every day and ask how they are going to beat the system, how they are going to make this work, and how they are going to make patients happy with less. Fortunately, we are doing a good job of it. At Kindred, we take care of approximately 2% of the healthcare population. We are taking care of the sickest of the sick. Sometimes our high-quality outcomes are simply getting somebody off of a ventilator. In the Palm Beach facility, 70% of our patients who enter on a ventilator are walking out of the hospital off of the ventilator. That is not a statistic that short-term acute care hospitals can brag about. We have different protocols and different relationships with doctors to move things like that along. On the other side, we are also the bridge to hospice. For some of our patients we know their time is short, but we try to bring quality to their last days while we are in this challenging environment of reimbursement and cost.

What is your outlook for the healthcare sector in Palm Beach County? 

I think the biggest challenge in the coming years is managed care. We are positioned very well to continue taking care of the aging population that we serve. As a long-term acute care provider, we are unique in that the average length of stay in our building is 30 days. Given the opportunity, we help patients that are very sick get better quickly so that they can go back to their regular life. Kindred is in a strong position to continue to help our community achieve those goals, help our physicians, and keep the community healthy and at home as opposed to in a hospital for an extended period.