Two years ago next month, Erlanger Health System Chief Executive Officer Kevin Spiegel - on the job for only 11 months - was literally worrying where the next dollar was going to come from.
Indeed, the amount of operating capital the hospital had going forward was on his mind.
"We were losing millions and millions of dollars," Erlanger Chief Administrative Officer Gregg Gentry said recently.
Fiscal year 2013, which had concluded the previous June 30, saw the hospital finish $8 million in the red and was the latest in a series of roller-coaster finishes for the medical center's bottom line.
Today, thanks to a 2014 infusion of federal money from the Public Hospital Supplemental Payment pool and an operations turnaround since, the hospital was $47.9 million in the black for fiscal year 2015.
And that, Gentry said, allows Erlanger to re-invest in places it couldn't when a positive cash flow for consecutive years was not happening. Although the hospital has made the upgrades and renovations it needed to along the way, including an ongoing major expansion at Erlanger East, large projects have been few and far between.
The first of those new re-investments at the main campus, the fundraising drive for which kicked off late last month, is a new Children's Hospital.
Since the current children's unit moved to the Erlanger campus more than 40 years ago, protocols have changed. Rather than children sharing space or being quartered in tiny individual rooms, many hospitals have moved to patient-centered family care, a warmer, more intimate way of dealing with the individuals involved.
"We have to evolve to state of the art," said Spiegel. "The children need it, and the community needs it. The current facility doesn't allow that to happen."
To be good stewards of their money and to maximize the bonds it can get, Erlanger will build the hospital - which will be across Third Street from the Chattanooga-Hamilton County Health Department - in phases. The first will be a $35 million outpatient center, which, at its current site, serves some 100,000 patients from 16 counties annually. An inpatient center is the second phase, and a combined women and infants' pavilion is the third phase.
A children's hospital, according to Erlanger officials, is not always a given for cities Chattanooga's size, so the Southeast Tennessee-Northwest Georgia region should view improvements here as an investment in economic development - one more thing that makes the Scenic City an enviable place to be.
For the first phase, Erlanger is putting in $11.5 million and must raise $23.5 million from the public. Of that, $8.1 million already has been raised.
The challenge, according to Erlanger Health System Foundations Chief Development Officer Julie Taylor, is the hospital has "never had a culture of philanthropy." Despite the fact it provides $85 million in uncompensated care annually (including $5.5 million in care for prisoners) - essentially making it easily the area's largest charity - it has not sought large amounts of money from the public.
However, to demonstrate to Wall Street bond-holders its ability to raise money, it must obtain the remaining $15.4 million by July 2018.
Fortunately, the conceived new hospital is a convincing story to tell.
Not only will it have rooms that offer the patient-centered family care that is demanded today, but it will be a place that is fun to visit. A vintage 1891 locomotive on loan from the Tennessee Valley Railroad Museum will grace the train-station entrance. Officials are in discussions with the Chattanooga Fire Department to use the cab portion of an old fire truck for children to play on. A tree house on the second floor is also planned. And officials from the Creative Discovery Museum have been consulted about exhibits in the waiting room.
And the planned curved and colorful glass exterior screams "cool," "new" and "innovative."
As Dr. Ralph Mohney, the former longtime senior minister at First-Centenary United Methodist Church used to tell members, "The good news is we have all the money we need for this project. The bad news is it's still in your pockets."
If area residents of the 16 counties served by Children's Hospital appreciate the fact such a facility is close by, if they are happy about the presence of - according to Spiegel - "the best physicians and talent" available and if they desire such a center to move forward with patient-centered family care in an inviting atmosphere, they should take the money out of their pockets and make an economic development investment in what Children's Hospital Executive Officer Don Mueller said is "the center of pediatric health for the entire region."
"It's time for the city to rise up and support this," he said.