Now is not the time to hold your tongue.
As the healthcare reform process unfolds in Congress, hospital managers should tell the public their views on what legislated changes could mean to patients.
For instance, a survey of 200 hospital chief executive officers conducted by National Research Corp. found that 45% of the respondents expect quality to slip under President Clinton's reform plan.
As community healthcare experts, administrators have a duty to speak out on what reform will mean to overall quality, provider choice, restraints on spending, technology usage, medical education and bureaucratic administration. In the healthcare reform debate, it's not politically correct to sit on the sidelines.
A number of counterbalancing forces are at work in the reform movement. Those strongly backing the Clinton bill or a single-payer system would rank cost control, universal medical coverage and consumer choice in order of importance. Those seeking incremental change or a scaled-down version of managed competition are on the defensive. They contend an ambitious government-sponsored program would produce bureaucracy, rationing and lower quality of care.
A majority of Americans already have decent insurance, and most are happy with their physicians and hospitals. Convincing them that they should pay more for an untested system created by wizards in Washington is no easy task.
Once healthcare executives cross the philosophical hurdles of rationalizing reform, they're left with the task of explaining how their organizations are preparing for change. The cleanest, clearest message emphasizes that local healthcare delivery is becoming more efficient, regardless of what happens-and when-in Washington.
But don't pull your punches. Explain the pros and cons on both sides of change. That may leave you vulnerable, but it also makes you accountable to your main constituency-the community. After all, the health system of tomorrow will be community-owned. As West Virginia Gov. Gaston Caperton said about his state's rural healthcare system: "It's not driven by the hospitals. It's not driven by the doctors. It isn't driven by the bureaucrats. It's driven by the people it serves."
With all the mixed signals, a confused public needs input from those who can articulate the impact of reform. Despite the media attention, a Kaiser Family Foundation/Harvard poll shows Americans "remain poorly informed" about the issue of healthcare reform. If political windbags and headline stories in daily newspapers and on nightly newscasts are failing to properly educate the public about reform, it's time for healthcare administrators to pick up the slack.