Herb Dyer has been the chief operating officer and vice president of Seton Medical Center Hays since the plans for the hospital were hatched in 2006, but in mid-July he transferred to University Medical Center Brackenridge, another member of the Seton system in Austin.

His replacement, Neal Kelley, took the reins of Seton Hays on July 15. Kelley comes from Seton Edgar B. Davis Hospital in Luling, where he previously served as chief operating officer and vice president. On July 24, Dyer reflected on his time at the hospital and Kelley discussed its future.

Was it a challenge to keep up with the growth in Kyle when the hospital first opened?

Dyer: I think it was a combination of challenges. For one, we have a planning department that defines the numbers for us, the statistics around demographics and how we build staff and equipment to support that. I think the first couple of months we had major challenges. The emergency department, we had budgeted 967 visits or so, and it was double that. It was more than two times the amount. So there were some challenges there.

What are the lessons you learned at Seton Hays that you will take with you?

Dyer: This was a totally [new facility], so some of the lessons are not applicable. For one, being financially conservative as far as holding expenses down. There are certain positions that I didn't fill initially. If I could do it all over again, I probably would have gotten more experienced leaders to fill some of those vacancies. I think it's also important that you get key people in place to oversee their respective responsibility.

What are you most proud of from your time here at Hays?

Dyer: Wow. The success of Hays as a whole. I think when I look at this hospital and bragging about the staff and seeing the statistics that define that 70-plus percent of people who were surveyed recommended this place to their family or friend, and seeing that the physicians, nurses and support staff are seen as great people basically the success of Hays. I think we have developed and grown a very successful operation here where the community and staff, they're proud of it.

How does the Affordable Care Act affect you going forward?

Kelley: I think there's always going to be that need for sick care. There's going to be that piece of the population that seeks core hospital services but what you'll start to see is as we manage these patients better on both ends, you won't have a need for readmissions on both ends and you won't need to have people in the hospital who otherwise could be seen in a less costly environment, because the emergency department and intensive care unit are the two most expensive places to care for a patient.

Dyer: I'm on the lower end of the baby boomers, but the realities over the next 20 years, you're going to have a significant amount of retired folks in the system, and no matter how well you take care of yourself, things are going to break down. The whole point is that you know you're going to have that [breakdown], so why wait for catastrophic moments? Let's talk about how we manage those things so we don't have to have emergency visits.

Are there any medical offerings you feel like Kyle is lacking? Any upcoming trends?

Dyer: I would say one of the things that's lacking here, and I hear it all the time, is pediatric service. Pediatric specialty, pediatric rehab. Right now, the wait for kids and athletes who may not necessarily have a private source [for rehab], they have to wait out several weeks or they have to go north to get that. That's something I think is very important. The other thing also is marketing the relationship we have with Communicare. Communicare is a federally qualified health clinic. It was built around supporting the poor and the vulnerable, but they are working to change that image because they have a very nice facility, and they have competent physicians.

What sort of changes will you bring to Seton Hays?

Kelley: If I were inheriting a big problem, you'd see drastic changes. I've been in situations where I've had to make some real programmatic changes to a particular area or facility. Since this is a well-run, well-respected, high-functioning place, I don't see dramatic change in terms how the community sees the facility. Yes, there will be growth. Yes, we will be very patient-centric.

Does having a background as a nurse give you an advantage as an administrator?

Kelley: Sure. I think that's always been one of my strengths: having been there and done some of the very things they're doing. I don't have to be an expert in everything. That's not my job. But yes, as an identification and a trust perspective, I've already seen some instances where nursing staff in particular but also physician staff feel very comfortable talking to me about things that they're challenged with or opportunities we may have that relate to that care at the bedside.