When Chris Accashian started working at Bon Secours Richmond Health System, the Chesterfield County native was assisting a development team working on the Certificate of Public Need so the health system’s planned hospital, St. Francis Medical Center, could be built.
Eighteen years later, he’s running St. Francis.
Accashian took over as chief executive officer of the Chesterfield hospital in April, replacing Mark M. Gordon, who was promoted to CEO of Bon Secours Richmond East hospitals.
“It was really exciting at that time,” Accashian said about working for the health system in 1998 while pursuing a master’s degree in health administration from Virginia Commonwealth University.
Back then he was pulling together data to help with the development of a Certificate of Public Need, or COPN, which Bon Secours needed approved by the state in order to build the 130-bed St. Francis.
“At the time I thought, ‘How cool would it be to work at this place?’” Accashian said.
Between his time working on the certificate and running the hospital, Accashian cut his teeth with HCA Holdings Inc., first at its corporate headquarters in Nashville, Tenn., before returning to Richmond to work with HCA Virginia as an associate administrator at Henrico Doctors’ Hospital and then as chief operating officer of Retreat Doctors’ Hospital.
He had a brief stint in Derry, N.H., as the CEO of Parkland Medical Center before a Bon Secours recruiter reached out to him about applying for the top position at St. Francis, which opened in 2005 and remains the newest hospital in the Richmond area.
It was a perfect opportunity, he said. The 41-year-old grew up in the Brandermill area — he graduated from Clover Hill High School in Chesterfield in 1993 — and said many of his friends and family still live in St. Francis’ backyard.
“I can pinch myself sometimes thinking about this opportunity,” he said.
But even the community he grew up in is rapidly changing. In 2010, Chesterfield’s population was just more than 316,000. By 2030, it is projected to reach over 390,000, according to the county’s 2016 demographic report.
Even the Brandermill area has changed dramatically since Accashian grew up there, he said.
“There is just tremendous growth,” he said. “It’s already occurred, and if you look over the next 10 years, there are (proposed) projects that would add a couple million square feet of commercial and retail, all in our backyard.”
“We’re already pretty full at St. Francis, so space and capacity is a challenge for us,” he added.
Last year, the hospital discharged 9,500 patients and cared for 52,000 in its emergency department. During its first year of operations, St. Francis discharged only 4,900 patients and had 22,000 patients visit its emergency department.
That steep local growth is taking place against the backdrop of a rapidly changing health care landscape in which uncertainties abound. Few know what President-elect Donald Trump plans to do to existing national health care laws and regulations.
Bon Secours Richmond Health System CEO Toni Ardabell said part of the reason she hired Accashian was because he understands the current health care environment, along with having the ability to “stay calm, be consistent about goals and have good follow-through.”
Accashian discovered health administration — and realized he wanted to pursue it as a career — when he volunteered at a free clinic in Charlottesville while attending the University of Virginia.
“I enjoyed that aspect of being able to address the entire community’s health as a health care administrator,” he said.
He decided to pursue his master’s degree at VCU and, while doing so, he needed a part time job.
While at Bon Secours, he spent most of his time doing market analysis on demographics and volume trends, along with anything that was asked of him by the planning and development department.
“It was so long ago that at that time I would hit enter on a database, go eat lunch and it still wouldn’t be done yet with all the numbers (when I got back),” he said.
The state awarded the COPN to Bon Secours after he left to complete his residency at Wake Forest Baptist Medical Center in North Carolina from 2000-2001. But he said his time as a planning analyst with Bon Secours instilled in him a love for planning, and he subsequently completed his residency in the planning department.
Working as a planning analyst taught him how to view the larger market. “I apply that still to what we do today, on a day-to-day operational business ... taking a step back and understanding the market and its growth and what we need to do to respond.”
“I think that has helped me come in here with a community that’s growing like ours is,” he continued. “Already, into my first few months, I’m applying what I learned to my job — the planning aspects of what we need to do for the next phase of St. Francis.
“We’ve been open for 10 years and there’s significant growth in the community, so how can we be responsible and responsive in our growth?”
The hospital has taken some steps in recent years to better manage its load, such as opening the St. Francis Watkins Centre, located about 4.5 miles away that has a freestanding emergency department along with physician practices. This summer St. Francis also received state approval to build two new operating rooms, though construction has yet to start.
But Accashian also explained that the solutions to St. Francis’ space challenges extend beyond additional construction.
“We’re working really hard to make sure people don’t come to the hospital if they don’t need to,” he said.
Mitigating hospital readmissions, ensuring the community has access to the appropriate preventive care and utilizing telehealth services all are tactics he said his team is employing to keep people out of the hospital.
But even those approaches have their own challenges.
“Utilization rates continue to go down for inpatient readmissions, but you have a growing and aging population that pushes against that,” Accashian said.
By 2035, the Richmond area will be home to more adults over 60-years-old than school-aged children for the first time in history, according to VCU’s Department of Gerontology.
“We’re really at the center of tremendous growth in western to southern Chesterfield,” Accashian said.
When Accashian applied for the St. Francis CEO role, Ardabell said it was clear his résumé showed he was well-suited for the position.
But it was his interview, she said, that really got him the job. Ardabell was previously CEO of Bon Secours St. Mary’s Hospital.
“He was very impressive. He had a leadership presence,” she said. “His values of keeping the patient in the center of decision-making, of compassionate care, collaboration with physicians, all this came out so well in his interview process that he was obviously the right choice.”
Accashian’s values lined up with those of Bon Secours’, according to Ardabell, which made him an ideal fit. He also has developed a strong relationship with the physicians at St. Francis, which she said is especially necessary to run a community hospital.
“The physicians drive your volume, and the physicians have to be convinced your quality of care is good, that all the patient experience is good,” she said. “All these things are important for the physician to be comfortable sending you their patients.”
Central to Accashian’s view of health care is ensuring the patient has a good experience, he said.
“When I was a 6-year-old kid, I remember going to the doctor at Sycamore Square just down the road (from St. Francis), and it took the whole office to hold me down,” he said. “I was just frantic with anxiety and fear, and I think that’s the emotion that everyone has.”
“I think back to myself as that kid who had tremendous amount of anxiety dealing with the doctor, and I realized that everyone feels a little bit of that. And at the end of the day when people are dealing with their own health or a loved one’s health in a hospital, they’re extremely vulnerable, and it’s a time when our providers and our caregivers or anyone on our team can have a meaningful impact on a person’s life.”
Every day he tries to remind his employees about the vulnerable position patients are in when they enter hospitals, he said, and to make a strong effort to provide communication that is meaningful to the patient.
“That’s the kind of culture I’m trying to build,” he said.
Right now he, his wife and their two children are renting a home in Henrico County and are on the lookout for a permanent residence. Returning to Richmond made sense earlier this year because their son, now 5, had not yet started kindergarten when they moved here in the spring.
His son “is a lot tougher than I was,” Accashian said, and gets shots like a champ.
But his daughter follows in her father’s footsteps — the 4-year-old runs away from the needle.