How the health system loses contact with clinicians – Health Care Blog
Jeff Goldsmith
Jeff wrote this article on July 5, 1998 for Hospitals and Health Network. He re-released it this week on his alternative, calling it the “27th Anniversary Edition.” This is an inspiring piece, but when you read it, ask yourself. What (if any) has changed and done better?Matthew Holt
Over the past 20 years, it has been difficult to impress the ability of both the U.S. health system and health care organizations. In a generational space, health services have evolved from the family industry to a substantial business. A series of new technologies have been added to the hospital's diagnostic and therapeutic capabilities. Hospitals have also been managed – although not always gracefully transitioning to a bed and community-based model of care.
Through all these changes, hospitals remain central players in the health system, and their economic status has been greatly strengthened despite regular political challenges. But the price of this success is terrible: the alienation of professionals is increasing, and these professionals are the lifeblood of health care and bear most of the risks of health care transactions.
As organizations integrate structurally, they collapse culturally. Not only doctors, but nurses, technicians and social workers have seen themselves transform into commodities and are marginalized by the entrepreneurship of health services companies. Professional dissatisfaction has intensified, as physician practices are increasingly included in hospitals, as health systems have begun rationed care through captive health programs.
The gap between managers and professionals and even between senior and middle-level managers has widened to it. Unions in the health sector have matured in amid its peak financial strength and record economic expansion. In fact, the labour climate among health professionals has become so hostile to management that organizing health services can revive the dying coalition movement alone.
Some of this tension is a byproduct of reducing the pressure to reduce the excess hospitalization capacity inherited by the health system. From current ownership concentration to consolidating excess capacity, inevitably means a reduction in labor or redeployment. The fact that the actual reduction in hospital workforce capacity so far does not mean that the pressure to lay off employees and increase productivity is not real and tangible, or will not increase in the future.
But the origin of labor problems in hospitals and health systems is deeper than the pressure to consolidate. In a generation, hospital management has transformed from a passive, custodial and largely benign “administrative” tradition to an aggressive, growth-oriented entrepreneurial management framework.
It is difficult to object to the economic success of these growth strategies. Since 1978, hospitals' net income has increased from $71 billion to more than $350 billion. Despite the challenges of custodial care, hospital profitability soared to record levels in 1997.
Meanwhile, the key interface between the custodial care, technology, and the key interface between professionals and patients (technology, key interface between professionals and patients) in most executive suites has occupied transactions and “positioning”. This migration does not happen overnight. Over the past two decades, hospitals have been reorganized, diversified, merged, “integrated”, established regional health care networks, evolving captive financing tools, and combined a surprising range of new technologies and services.
The resulting modern enterprises are usually huge billions. The health system is not aware of this and has grown to the point where patients and caregivers they have to work in. What a powerful capability, many healthcare businesses have grown beyond human scale and have lost their focus on the daily struggles that take place within the wall.
The focus on growth also leads to the failure to develop or encourage the excellent operational culture required for frequent, effective, and safe operation of the health system. Until recently, health service researchers began measuring the cost of using our increasingly complex health systems.
Hospital infection rates have risen by 36% over the past 20 years. Of the causes associated with treatment each year, as many as 180,000 Americans die in hospitals, and about half of them are preventable. Adverse drug reactions are believed to kill 100,000 patients per year. In many metropolitan areas, the risk of death for common surgical procedures varies by five times between hospitals, and the human cost of using it is incredible given our health system capabilities.
Most Americans have neither the scale of the risks they operate nor the ones they know. They believe that some invisible troops-government, perhaps, has created a uniform high quality standard that can protect them when using the health system. But the hallucination is disappearing, and instead it is consumer vigilance.
The difference in quality provides a wonderful strategic nature to be besieged managed care companies, allegedly disrupting medical practices and undermining the quality of care. The best way for a health program to transform its image from a consumer rival to a advocate is to “transparent” to substantial quality and cost differences in the U.S. healthcare system. By providing patients with information and financial incentives to select the highest value providers that pose the lowest risk, a managed care plan can help families wisely utilize the options they need.
Mastering health care operations and instilling a culture of continuous clinical quality improvement can provide severe missing ingredients to the health system. Promoting operational excellence is the logical next step in the development of health system management. Building a culture of intolerance avoids avoidable systemic medical errors and establishing a collaborative framework to define what constitutes the best medical practice will help reintegrate professionals, managers, experts and primary care providers, supervisors and caregivers.
After all, as everyone ages, it is inevitable that they use the health system. Efforts to achieve standards of excellence will bring measurable benefits to individual patients and society as a whole. Executives in hospitals and health systems applaud privately the public's hostile perception of hostile care is becoming increasingly hostile – but they can't see the same brush that will make them tar.
The American people don't like the medical faces of the new company. They don't distinguish between for-profit and non-profit healthcare, or, surprisingly, between managed care plans and provider groups. Americans are increasingly convinced that the driving force behind new healthcare businesses is that money does not meet their care needs.
This is not an image problem. This is a realistic question. Addressing it should be the focus of health care managers and trustees. Healthcare businesses of all sizes are the managers of community health. Restoring human scale and values for health systems is crucial to those who manage our health businesses. Unless these businesses can organize to provide measurable value to consumers, the health services management revolution will prove short-lived unless managers can unify their organization to improve the lives and well-being of people in their communities.
Reconnecting with health care professionals and reconciling professional and management values in hospitals and health systems is an important prerequisite for creating a safer and more responsive health system.
Jeff Goldsmith is a veteran health care futurist, president of Health Futures and a regular THCB contributor. This comes from his Personal substitution
