When it came to growth, New Hanover Regional Medical Center officials saw no choice in the matter.

In the past several years, “large hospitals have gotten larger, and smaller hospitals have been squeezed out,” said Dick McGraw, chairman of the NHRMC Board of Trustees. “We either had to grow or be bought by somebody or merge with somebody … our first priority is serving this community, and if we were to merge with somebody else, that might not be the case.”

As a result of that prediction, McGraw said, hospital officials “adopted a fairly significant growth strategy – a policy and strategy to not only serve New Hanover, Brunswick and Pender counties but the surrounding counties, a total of seven counties with both physical facilities and with lines of service.”

That strategy has becoming increasingly high-profile in recent years and months as NHRMC, the largest employer in the Wilmington area, celebrates its 50th year in operation next year and prepares for a change in leadership.  

Jack Barto will step down as CEO of NHRMC on Dec. 31 and be replaced by president John Gizdic on Jan. 1. Gizdic, formerly COO, became president this summer as part of the hospital’s transition plan.

Barto has led the hospital through more than a decade of major changes, officials said.

“That was one of the first things Jack did when he came almost 13 years ago, working with our board, putting a strategic plan in place, putting a vision in place on what this organization could be and then executing on that,” Gizdic said in a recent interview. “But at the center of that and the reason I think we have been so successful is that strategic plan, that vision, put the patient first. And if you start with the patient, the rest will follow.”

Gizdic also credited the quality of employees and the medical staff and a greater emphasis on customer service, while also acknowledging the role money had to play.

“Being able to invest in the community required us to have a strong financial position and a stable financial position over the past decade or more,” he said. 

Gizdic said NHRMC has invested almost $1 billion in building projects, technology and equipment in the past 10-12 years, with another $200 million investment on the horizon. Although the details are still being worked out, existing and near-future growth in facilities is expected to require a bond issue of about $150 million, Gizdic and Barto said recently.

Hospital officials said the issued bond is expected to help pay for a number of proposed projects: an orthopedic inpatient hospital at the main NHRMC campus on 17th Street, to be housed in a new tower above the hospital’s existing surgical pavilion; inpatient endoscopy services relocation at the main campus; outpatient endoscopy services; an ambulatory outpatient health pavilion facility in a different location, likely somewhere in the medical arts district near the hospital’s main campus; a midtown Wilmington emergency department with imaging and rehabilitation services; and intensive care unit renovations at the main campus. 

If approved by state regulators, those inpatient orthopedic services would move from NHRMC’s Wrightsville Avenue facility, formerly Cape Fear Hospital, which would likely be put up for sale after a transition period, Gizdic said.

He said the inpatient orthopedic facility above the surgical pavilion will likely be the most costly, with a potential price tag of $100 million.

The midtown ED would be similar to NHRMC’s ED North, a new emergency department in northern New Hanover County that opened last year at 151 Scotts Hill Medical Drive. Before ED North was built, officials projected that the facility would see about 35 patients a day, but currently, twice as many people use it on a daily basis, with the highest number recorded at more than 100 in a day.

As a result, the hospital is also looking at expanding services in the area, both at the facility and on adjacent land the hospital owns.

Some of those ED North patients have come from Hampstead and even as far as Jacksonville, Gizdic said. 

“Jacksonville’s one of the top three zip codes [for patients] for our ED North,” he said. 

As another testament to ongoing NHRMC growth in areas near Wilmington, Gizdic pointed out, NHRMC is building a 50,000-square-foot medical office building in Jacksonville.

In July, a 24/7 Wall St. analysis highlighted Jacksonville as shedding doctors the fastest, based on data from the U.S. Department of Health and Human Services.

“They don’t have enough physicians,” Gizdic said.

Another area of major expansion for NHRMC over the next few years, official say, will be Zimmer Cancer Center, which is set to double in size.

“Cape Fear Cancer Specialists will be moving their practice into Zimmer Cancer Center, really creating a destination center for oncology services in the region and taking that into the next level,” Gizdic said. 

More growth means the need for more parking. 

“On campus we continue to try to find and squeeze out every parking space we can get,” Gizdic said, but the hospital is also looking at other options, planning to build a 750-space parking garage across from the main campus that would be connected with a pedestrian bridge, pending city and N.C. Department of Transportation approvals. 

The new 17th Street Deck and Skywalk Project is estimated to cost about $18 million, officials said.

Another potential parking lost that would have about 60-65 parking spaces next to the Glen Meade neighborhood has met with opposition, so Gizdic pulled the project from a recent city meeting agenda.

“We’re trying to see if we can work with the neighbors to reach some compromise, to figure out a good situation,” he said.

The parking garage would provide more employee parking, freeing up spaces for visitors and patients at the main campus. 

The hospital’s employee numbers have grown in addition to its footprint, by more than 2,000 additional employees over Barto’s tenure, bringing the total to 6,300.

When faced with choice between growing or shrinking, McGraw said hospital officials handled it deftly.

“Jack [Barto] is a visionary; Jack saw this coming,” McGraw said. “Board members are not likely to see that on a day-to-day basis. We do hear from trustees and experts as to what’s happening in health care and hospitals, but we don’t see it on a day-to-day basis like the senior management team does … Strategic growth was a key component – where to grow and how to grow.”  

As for future growth, Gizdic said, the health care industry is changing, with payment models expected to necessitate more proactive, preventative measures.

“We’re still going to need hospitals and health care facilities, but the goal will be to utilize those less and less because we’re trying to keep the population healthy,” he said. “We’re trying to manage people’s health, so it’s really moving from hospital-centric to health-centric, which I think is one of our challenges moving forward as an organization and an industry.”