In recent years, the healthcare industry has undergone tremendous change. Many new financial and organizational strategies have been implemented to help healthcare organizations of all types ensure their survival and secure their future. It seems that this rush toward the new has left many consumers believing that healthcare organizations have moved away from their core values.
Our organizations and peers are under scrutiny for everything from suspected fraud and abuse to shortchanging patient care to save a few dollars. The need to restore public faith in our organizations and the healthcare system as a whole is greater than ever.
The key to restoring public confidence is integrity. It's also the key to genuine leadership. Integrity is not a "flavor of the month." It is a timeless asset that some healthcare finance professionals may have de-emphasized in their efforts to be seen first and foremost as strategic-minded, results-oriented leaders.
Leading with integrity is a tremendous challenge. Our integrity can be tested because of our fiscal responsibilities to see that our organizations continue to provide quality healthcare in an era of constrained resources. With all the fiscal pressures we're facing, we're being forced to be much more cost conscious. As a result, many organizations aren't just trimming fat, they're carving into muscle.
Technology, although a wonderful tool, can move like a speeding train, bypassing our sincere efforts to monitor and manage the activities for which it is being used. Many of us try shortcuts that can get our organizations into trouble.
We also must deal with sometimes-contradictory rules, regulations and interpretations. My own organization has been challenged by New York's attorney general for alleged violations of antitrust laws as a result of a collaboration with a neighboring hospital, an arrangement that previously had been approved by the state of New York and the U.S. Justice Department. Last month a federal court entered a partial summary judgment in favor of the attorney general. We are obviously disappointed by the decision, because the hospital relied on the word of the state regarding the arrangement.
It starts at the top. Keeping integrity at the forefront of our activities is a must. Instilling a culture of integrity has to come from the top, such as the governing board or senior management. Employees take their cues from the top. If we fail to actively pursue integrity in our organizations, we risk paying too great a price. Obviously, we risk incurring regulatory penalties and even prosecution for abuses that are uncovered. More serious, however, is the damage we can do to the public trust.
The perception of a lack of integrity can erode public confidence in our ability to provide the healthcare services that are our reason for being. Market share can drop, perhaps so much that we find ourselves forced out of business. Or the erosion can come from within. Employees may become so demoralized working for organizations where integrity is expendable that they decide it's better to leave. As turnover increases, organizational effectiveness decreases. Clearly, a lack of integrity can take a heavy toll on the bottom line.
Guideposts to integrity. While it's easy to take a wrong turn as we work to maintain high-integrity organizations, there are a few rules of the road that can keep us moving in the right direction. Leading with integrity requires that we stay informed so we recognize the issues. Executives must base financial decisions on the facts and also realize the ethical implications of those decisions. It's also important to understand the culture in which an organization operates. Employee attitudes about ethics need to be identified and addressed. We must raise awareness among employees at every level that there is a single, ethical standard we expect them to uphold.
The Healthcare Financial Management Association's code of ethics outlines the essence of what it takes to be an ethical financial manager. It requires individuals to:
* Practice honesty and maintain personal integrity.
* Strive for the objective and fair presentation of financial information.
* Foster excellence in healthcare financial management by keeping abreast of pertinent issues.
* Maintain the confidentiality of privileged information.
* Seek to maintain a reasonable balance between the quality and cost of healthcare.
Educator, adviser, and author Robert Cooper spoke at the HFMA's 1999 Annual National Institute on the topic "Excelling under Pressure: The Need for Exceptional Leaders in Healthcare." Cooper asserted that true leadership requires managers to focus as much on the human side as on the technical aspects of their jobs. Cooper defines emotional intelligence as the ability to sense, understand and effectively apply the power and acumen of emotions as a source of human energy, information, connection and influence. Cooper's concept of emotional intelligence dovetails with my theme as HFMA national chairman: "Leading with Integrity: The Bottom Line." The payback for becoming an emotionally intelligent leader can be seen tangibly in more-effective organizations, improved profitability and staff morale, and greater success in implementing change.
As managers, we all have the responsibility to be a moral compass at our organizations. If we can honestly say, "The buck stops here," we have taken an important first step. The way to serve as a moral compass is by becoming a sounding board and guide for everyone we meet; not settling for the easy solution; hiring people of the highest integrity; and not being afraid to confront problems and challenges. As Mark Twain said, "Always do right. This will gratify some people and astonish the rest."
Richard Henley is executive vice president and treasurer of Vassar Brothers Hospital in Poughkeepsie, N.Y., and 1999-2000 national chairman of the Healthcare Financial Management Association.