I spent a day visiting a hospital whose corporate owners and investors expect to make an annual profit.
This was Henrico Doctors' Hospital in Richmond, a neat, clean 312-bed medical facility in a neat, clean neighborhood of neat, clean modest-sized homes.
It is one of a chain of 416 hospitals with 60,404 beds operated by the Hospital Corp. of America in Nashville, far and away the world's largest investor-owned hospital group.
Though I have been in scores of hospitals as a reporter, visitor and, a few times, as a patient, I had never been in a commercial, operated-for-profit hospital before.
My first reaction was that it was cleaner than most Washington hospitals.
My second was that it was run by managers who are acutely aware of the need to please both patients and their doctors -- both are a hospital's customers -- to succeed in a world in which many hospitals have rows of empty beds.
My third was that HCA had the right managers here to do so with maximum business-like efficiency.
"You really do the same thing in every hospital," said J. Stephen Lindsey, the hospital's 38-year-old executive director. "The basic thing is to deliver good care. Then we try to be as efficient as we can."
Among tools to increase efficiency, he described:
* A close watch on nurse-patient ratio, so as to have enough but not too many nurses on any ward. There is daily computerized monitoring of ward-by-ward staffing and "acuity of illness," so "we can move staff around depending on how ill patients are," he said.
* Use of full-time registered nurses, mainly, at a time when many cost-conscious hospitals are relying on many part-time nurses, practical nurses and nurses' aides. "We think it's more efficient to have dedicated career nurses and RNs who can do everything."
* Daily tracking, again by computer, of department by department income and costs.
A patient representative visits every new patient. Every patient gets a questionnaire in the mail -- to state compliments or complaints -- after leaving.
Lindsey showed off a heart pavilion where surgeons do six or seven open-heart operations a week, and a mother-and-infant unit where a mother may keep her new baby with her from delivery onward.
"These people are highly cooperative whenever any new equipment is needed," said Dr. Charles James, a busy orthopedic surgeon. "You don't have to go through the numerous committees, there isn't so much lag time" as there might be in the usual nonprofit community hospital with a large board of directors.
An impressive 85 percent of this hospital's doctors are board-certified by speciality examining boards. They are offered no stock-participation deals, but "a lot of them" have bought HCA stock, Lindsey said.
The hospital aggessively markets itself. It has started an educational breast health program for Richmond women, which not incidentally will refer women who need care to a physician, who not incidentally is a staff doctor.
A current "goal," Lindsey said, is to increase the number of heart operations and childbirths. This hospital, one of four with maternity wards in the Richmond area, has already cornered 40 percent of all births.
The hospital is currently 75 to 80 percent filled, on the average -- a marketing success in this day of generally shrinking hospital stays.