If I can draw an analogy from cosmology, the development of the first vertically integrated systems was the "Big Bang" that started the new paradigm in healthcare.
We now must prepare for another "Big Bang" in the form of healthcare reform.
We face a national crisis in systems building. Now, everyone seems to believe that community-care networks and regional, comprehensive systems are needed to make healthcare affordable. If that's true, we need to identify the major stumbling blocks to building such systems and take steps to make them operationally effective.
Identifying community.First, we must redefine our notion of "community." When building the Greenville (S.C.) Hospital System, I defined community as the local county and neighbors served by GHS medical staff and hospitals. If specialized services beyond those available at GHS were needed, Emory University Hospital was accessible to the south and Duke University Medical Center to the north.
I believed then, and still do now, that any system should have community leadership and control. However, the communities will be multicounty, and the relationships will be more difficult to manage. Institutions and services in major markets will need to be integrated administratively, financially and medically.
To accomplish these changes, the hospital system chief executive should focus on three matters-the community, the organizational structure for the provision of services to the community, and the future. No longer will health executives have the luxury of wasting time and effort on other little issues while ignoring these three major concerns.
The future will require planners, demographers and, most importantly, epidemiologists. Within a given geographic area, there must be collaboration and cooperation. That's because competition won't be local but will involve other massive and competent systems.
Defining healthcare. Just as we need to change our perception and definition of community, it will be even more important to redefine the meaning of healthcare. We must pay more attention to health status, as well as disease status, and begin to build social models of care that incorporate community-based efforts to improve health status as well as to cure diseases.
The medical model will continue to be viable. However, we must also embrace a more comprehensive and collaborative approach to health. Communities have numerous health service organizations, and all must be drawn into or affiliated and synthesized with the new organizational entity. Most importantly, all public health departments, all the services they provide, all the concerns with which they work, and all the population targets in their markets must be included as part of the new systems.
Today, we seek control at the level of our local, immediate neighborhood and communities. Our heart is in the right place because we believe in local community control. But we will be operating new organizations that must be merged with others. The leader of the new structure then must be capable of managing an array of resources that are necessary to serve the population of the larger region and doing so in such a way that it has greater impact on health as well as sickness.
An expanded universe.In short, healthcare leaders must learn to operate within an expanded regional community and offer expanded health-related services. They will need to achieve competence in serving the larger community and its well-being. Regional communities and the expanded service areas must be capable of sustaining a full array of integrated healthcare organizations. We need many more hospital, medical and healthcare mergers.
As this occurs, it will be necessary that new forms of governance, local advisory boards and regional and local medical care corporations keep the smaller, more traditionally defined communities thoroughly informed and have high regard for their views concerning their destinies. The regional approach must not ignore the smaller local neighborhoods and communities.
In sum, the future won't be an extension of the past. We must achieve a perception that the past and its successes won't bury the future. We must be aware that the provision of healthcare services isn't a political conflict but a moral and societal issue. With this perception, the future may become a matter of pride, accomplishment and success.