The economy is having an unprecedented effect on healthcare. Understandably, money-strapped patients would rather buy food and other necessities instead of nonimmediate healthcare services. Faced with declining patient volume and revenue, hospitals and healthcare systems around the country are making difficult, financially motivated decisions—just like everyone else. In times like these, chief executive officers, hospital boards and financial officers are tasked with slashing costs to keep the bottom line strong.
Unfortunately, some might opt to cut programs that address quality and patient safety, because results in those areas are harder to measure and the positive financial impact takes longer to realize. I think staying focused on improving quality and safety offers a strategic advantage in both the short and long term.
Let’s start with our original collective intent for choosing healthcare as a profession—to improve the health of those who come to us and to care, to truly care. Continuous improvement in the way we provide care is what patients expect us to do and is the true joy for us in the workplace, even in the C-suite. Staying connected to this motivating sense of purpose is the most important component of any effective effort to retain executives and other high-performing employees and to engage physicians.
Continuing to invest in quality and patient safety is more than a luxury—it’s a matter of survivability. Despite early disappointing evidence, we know patients are looking for objective quality data now more than they did even five years ago. I predict that my children (ages 13 to 20) will choose their care providers based on measurable results of quality and service using the Internet similar to the way many of us use the Internet now to purchase other items and services.
Indeed, the current financial climate of high deductibles and copayments will likely accelerate that demand in the short term. Transparency will be more than a buzzword used in the healthcare industry. It can become the norm. Patients and employers are only now beginning to demand accurate and understandable performance metrics about clinical processes, outcomes and some method of assessing the patient experience. Providers demonstrating high levels of performance on things that matter to patients will be the only ones left standing in the future.
The best way to weather the current economic storm and prepare for the future is to build “improvement capacity.” Almost all businesses have waste or work that has no value. Our calling should be to focus on improving quality and reduce waste vs. cutting cost. This will create sustainable cost structures that will not have to be “rebuilt” or “restaffed” after the financial crisis subsides.
It will challenge us to define the tasks that we as leaders, staff and physicians do on a daily basis that actually provide value to patients and eliminate those activities that do not. In the short term, removing waste and rework will simultaneously lower costs, improve quality, improve the patient experience and improve morale. If the future of healthcare changes from the illness-based payment system we know today to a model that funds improving population wellness, then focusing on improving quality, service and reducing waste will be the only sustainable long-term strategy.
Now also is the best time to focus on development and training of our employees. Historically, employees and physicians who perform well as clinicians are “promoted up the ranks” to leadership positions without additional training or development. We assume that if someone has been a good radiology technician, then that person will be a good radiology director.
This stark contrast with other industries was made clear to me through the experience of my 16-year-old son. He is a high-school student working part-time at a local fast-food chain. His manager promoted him to shift supervisor, and my son spent eight hours in training for his new role.
Meanwhile, a colleague of mine was promoted from manager to vice president of operations of a hospital with only a job description and a briefing of his new responsibilities. That lack of specific leadership development and/or training is even more pronounced as we attempt to engage successful physicians into the ranks of physician leadership. Instead, we complain that physicians seem to have a hard time understanding things as we do.
It seems likely that this bad habit of ours will be reinforced in the current economic times where the temptation to cut training and development is unusually strong. Instead, let’s consciously invest in developing a workforce and physician partners who are prepared to lead in the challenging times ahead. And, we will have to do it with existing resources. Are you up to the challenge?
We often hear and say, “no margin, no mission.” That’s what got us into this mess. I suggest we try “no mission, no margin” as a way of moving forward. It’s more rewarding. And, more importantly, it’s the right thing to do.
Leigh Hamby, M.D.
Executive vice president and chief quality officerPiedmont HealthcareAtlanta Submit a letter to the Modern Physician Reader Blog. Please include your name, title, company and hometown. Modern Physician reserves the right to edit all submissions.
