St. Luke's Hospital in Columbus, North Carolina, had been planning to ink a management agreement with AdventHealth, one of the nation's largest health systems, for months. But just days before the transaction was scheduled to close in late September, a wrinkle emerged: Hurricane Helene.
The storm was catastrophic in just about every way, but it was an unexpected "blessing" in at least this one, leaders from both entities told Newsweek. It accelerated a cultural bond that sometimes gets lost amidst financial analyses and compliance reviews.
The critical access hospital sits at the foothills of the Blue Ridge Mountains, rendering its facility and employees vulnerable to the brewing Category 4 storm. As Helene barreled toward land, Mike Thompson, president and CEO of AdventHealth's Southeast Region, and Bill Miller, St. Luke's board of trustees chair at the time, had a difficult decision to make. If they abandoned the transaction, the hospital would be left to weather the storm without the resources or support of a larger partner. If they went through with it, they would have to abandon the traditional playbook.
AdventHealth—a 54-hospital system spanning nine states, headquartered in Altamonte Springs, Florida—had planned to send human resources, IT and administrative employees to Columbus. Alas, Thompson told Newsweek, "putting 50 people into a natural disaster is not a great plan." The transition team would have to work remotely.
The storm also raised new budget concerns for AdventHealth. Helene would strike on Thursday, September 26, and the transition was scheduled for the following Tuesday, October 1—so the hospital's condition was in question.
"It was not ideal, because we're taking financial responsibility for an asset, and we didn't know what condition it would be in," Thompson said. "Anytime you're running [a hospital] in a natural disaster, you're going to have poor financial performance."
But there weren't many alternatives. St. Luke's managing partner at the time—Charlotte, North Carolina-based Atrium Health—was stepping away, and the organization was counting on AdventHealth to take over. Under the proposed 20-year lease, the larger health system would assume responsibility for the hospital's assets and financial output.
St. Luke's was unlikely to make it on its own, according to Miller, who served on its board for approximately eight years. The outlook for rural hospitals has grown increasingly grim: Nearly 200 have shuttered over the past decade, and more than 700 are currently at risk of closing, according to a November report from the Center for Healthcare Quality & Payment Reform. For hospitals like St. Luke's, a financially resourced partner has become a necessity; there was not a great option to delay, Thompson said.
The decision to move forward despite Helene was a "godsend," Miller said: "If we had just been left out here on our own, it would have probably been a tragic situation."
Still, it would be challenging to seal the deal. As soon as the storm hit, Miller drove about 90 minutes to Charlotte to find a hotel with internet and connect with Thompson. He then needed to obtain signatures from board members and other stakeholders, but most people in Polk County did not have power or cell service and were unreachable. Despite road closures, Miller was able to track them down in-person.
Both entities got to work once the deal had closed—but it wasn't typical integration work. After a "normal" transaction, AdventHealth would help employees sign up for health plans. After this one, AdventHealth helped them clear their driveways and ensured everyone was OK. The system bused in clinicians and facility leaders from Georgia to help. Helene led to 103 fatalities in North Carolina alone, but none of them were hospital employees, Thompson said.
AdventHealth also leaned on its supply team and vendor connections. The health system had semitrailers packed with fuel, water and resources in Atlanta, and was able to enter western North Carolina around the same time as FEMA, according to Thompson.
"In these situations, the relationships you have throughout the industry become incredibly important," Thompson said.
St. Luke's staff expected some technical support from its partnership with AdventHealth, like a streamlined documentation system, according to Stephanie Postol, the hospital's executive director of nursing operations. Still, they weren't sure what to expect, as they felt siloed in previous management relationships.
"It's the fear of the unknown," Postol said. "You hear that things are going to be good, but until you actually see it, you really don't know. "
Helene helped to humanize the transition and proved that AdventHealth was truly there to help, per Postol: "The biggest thing is being intentional and really getting down to the front-line staff."
The unexpected circumstance added an "emotional dynamic," which was a net positive, Thompson agreed. Now, he's reflecting on how larger entities can bolster trust with the smaller organizations they manage and acquire.
While legal constraints prevent too much preliminary team building, "there are better methods than the historical, cold, transactional ways," he said. "You may not have a galvanizing event like a natural disaster, but there's no replacement for [new employees] seeing you together."
"It has to be a long enough period of time that you can't fake it," Thompson added, "and they can't fake it."
Postol said the staff at St. Luke's—now AdventHealth Polk—are still feeling that support.