Guest Commentary: Put focus on outcomes

"Building or maintaining market share often comes down to who can better engage and build relationships with physicians.” That's the opening line of a seminar description in a brochure promoting a national conference for hospital senior management.

SEE OUR ESSAYS ON REFORMSubmit an Essay for ConsiderationWhile the national media are full of discussions on healthcare reform indicting our healthcare system for shorter lifespans and higher infant mortality rates than other countries, escalating healthcare costs, inefficiencies, preventable deaths and injuries, as well as tens of millions of uninsured or underinsured, the topics at meetings of hospital management are often focused on market share, bottom-line benefits, transaction models, evidence-based leadership, referral and retail strategies, social media engagement, surgical profitability and service-line management.

This nation is in a fist-fighting, name-calling turmoil over healthcare system deficiencies. And people are demanding change, with the entire world watching the spectacle of the most powerful nation in the world admitting that its system of high-tech hospitals, specialty physicians, insurance companies and drug manufacturers hasn't produced world-class outcomes.

Many hospital managers are buried in market-share analysis rather than monitoring clinical and functional outcomes of patients. Attention is focused more on margins than on improving patient safety in surgical suites. Hospital Web sites are sprouting social media links, including Facebook and Twitter, while most hospitals are neither taking time to talk with patients, face-to-face, about their hospital experiences nor bringing physicians, nurses, patients and family members together in one room to review the effectiveness of medical and surgical treatments.

Hospitals are proud of their engagement of programs to change employee culture, with careful measures over time of cultural indexes, comparing one hospital to groups of hospitals. But there is often little attention paid as to whether these culture scores have any correlation with quality measures, such as return to surgery, infection rates, survival rates, readmission rates, adverse events and medical errors.

One hospital manager told me, excitedly, “Our culture index is higher now than it was last year and so are our patient-satisfaction scores!” I asked him whether a higher culture index and being in the 95th percentile on patient satisfaction had any relation to patient outcomes. Stunned, he said, “I don't know. We haven't looked at that. Are you saying we should?”

There are hospitals that do this. They are focused on safety measures, outcomes, quality indicators such as disease transmission and other hard numbers that show hospitals are providing the most appropriate surgical or medical options. At these hospitals, patients are treated only with medically indicated tests, and by physicians who are more concerned about working as a team on a patient's care than they are about generating income enough to pay themselves as well as their rent and office staff.

Hospitals such as the Cleveland Clinic, the Mayo Clinic, Rochester, Minn., and Intermountain Healthcare, Salt Lake City, are frequently mentioned in the popular national media and in public debates as examples of what hospitals should be like across the country.

Many hospitals are changing their measures of success to focus on coordination of patient care and improving patient outcomes. These hospitals are finding that there is an inverse relationship between cost per patient and quality of outcomes: the lower the cost, the higher the quality of patient outcomes. It is not surprising that our nation's high expenditure on healthcare, technology and drugs is not reflected in the health and fitness of the people in this nation.

Hospital CEOs need to be spending more time paying attention to what the people in their communities are saying they want and need from their hospital and less time in cramped airplanes, crowded airports and cold hotel meeting rooms in Chicago, Dallas and San Francisco listening to well-known, podium-worn speakers who are so far, far removed from the issues back home in Walterboro, Baytown or Maysville.

CEOs should stay home, save money and go door-to-door in the evenings to listen to what little-known people in their community say they want from their doctors, nurses, insurance providers, pharmacists and community health professionals. When CEOs step into these living rooms, they will have to compete with high-definition, flat-screen TVs equipped with surround sound. The TVs will be showing fast-moving reality dramas and young singers and dancers vying for national honors with spirited songs and new moves.

CEOs who focus on outcomes and health status will demonstrate their talents and their agility in the homes of people in their local communities, with heart-wrenching health dramas playing out in each of these homes, and highly talented nurses and physicians in supporting roles. By focusing on outcomes, CEOs will get the applause they deserve as they make their hospitals highly affordable and highly effective in not just healing the sick and consoling the dying but in preventing illness and promoting community health.

Emerson Smith is a clinical research associate professor of medicine at the University of South Carolina's School of Medicine, Columbia, and a medical sociologist for Metromark Research, Columbia and Dallas.

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