Notes on the news:
Three strikes ...
Executives aren't the only ones who should be ejectable
In last week's issue (Dec. 5), reporter Paul Barr wrote about a proposal in the Empire State that could result in the ouster of hospital executives and trustees.
The authors of a new report suggest that, among other things, the state health commissioner be given the authority to replace hospital management and remove board members to force out self-interested and unqualified officials to reverse the declining quality of care in the borough of Brooklyn. The report is part of an effort to reform Medicaid, and its authors were led by financial executive Stephen Berger. He also led a statewide restructuring commission that ordered the closure of nine hospitals and the reconfiguration, affiliation or conversion of 48 others (July 7, 2008).
The new report argued that “The boards of some of these hospitals have failed to satisfy fully their responsibilities to the organization and their communities … Instead, they have adopted a strategy that seeks merely to be the last man standing in their communities.”
Not surprisingly, the dramatic notion of forcibly changing the management and governance of hospitals was greeted with a chilly reaction by the New York hospital community. “We're generally opposed to that,” a state hospital association spokesman remarked with great understatement.
There's an intriguing principle in this controversy. If hospital administrators can be booted out for failure to act in the best interests of the community, shouldn't this also work in reverse? Healthcare executives and boards being allowed to eject public officials who serve only themselves? A good place to start would be Congress. (Motto: “We are the 9%—public approval rating.”) Many lawmakers have demonstrated repeatedly that they don't care about ordinary Americans' health or the country's health infrastructure. They will, without hesitation, sacrifice the public interest to get re-elected and collect their perks.
Wouldn't it be nice to march into their offices and shout, like a major league umpire, “You're out!”?
Speaking of Congress, a bloc of its dubious solons can now take responsibility for the departure of Dr. Donald Berwick as head of the CMS after 17 months. You will recall that monolithic GOP opposition to healthcare reform led those lawmakers to oppose Berwick's nomination as well. When President Barack Obama used a recess appointment to install Berwick in office, the Republicans made it clear they would not confirm him permanently when the recess appointment expired.
Berwick, a noted patient-safety expert, was one of the most qualified of all the people who have led the agency. Most of his adversaries wouldn't know patient safety from a free safety. Thomas Scully, who headed the CMS under President George W. Bush, last year noted the downside of the hyper-politicized atmosphere in Washington:
“He's universally regarded and a thoughtful guy who is not partisan. I think it's more about … the healthcare bill. You could nominate Gandhi to be head of CMS and that would be controversial right now.”
In a just world, the lawmakers who twisted Berwick's comments and record to besmirch him will have done more damage to their own reputations than to his. Many of them will someday need hospital treatment. We can only hope that just before discharge, their doctor comes around, puts a reassuring hand on their shoulders and says, “It used to be that a lot of people were seriously injured or killed as a result of the procedure we just performed. But thanks to Don Berwick and his fellow safety crusaders, you're going to be just fine.”
Keep the crash cart ready.
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