Tuesday, July 19, 2011

Politics and the Inevitable Decline of the Community Hospital

If you pay close enough attention to the executive staff at some community hospitals, you can't help but notice that every few years they seem to have a new C.E.O. or C.O.O. or some other honcho at the top.  Whenever I see this trend the first thing that pops into my mind is "Politics."
Although, some clawing your way to the top is to be expected in all corporations and management is prey to "better dealing," I believe that this trend signals a bigger issue and poses a serious danger to the survival of hospitals in general, small community hospitals in particular.

The real issue is not so much the back biting of politics but rather where the political climate leads.  I have seen some hospitals where "just perfect" is the catch phrase of the day.  Picture a board meeting with the heads of the various departments seated around an oblong table and one by one each department head presenting a report for a new business venture.  "Billing?" "Great!"  "IT?" "Great!" Etc. etc. etc.
Round and round each member of management making sure that no boat was rocked and NO problem was addressed.

Unfortunately, this is the consequence of the political life - making sure that CYA is taken to the extreme, hiding out to protect your job at the cost of making significant changes that would increase revenue.  Playing "nice, nice" with the big boys at the top.  Believe me, you would never see a successful private practice using these tactics - you would never see any successful private corporation believe that issues be hidden under the table.   Small community hospitals are taking a big hit these days and have a large bitter pill to swallow with all the changes in reimbursement and coding that is coming their way.  Larger hospital corporations are gobbling up these harbors of the community like small fish in a big fish pond, and soon their very existence will be a thing of the past.

Another huge error in the community hospital is promoting the nursing staff to positions outside of medicine or even within hospital based practices.  My sister has been a nurse for thirty years, and I am well aware of the overwhelming responsibilities of this profession.  In todays' market, every hospital is understaffed and nurses are inundated with paperwork and an exploding, less tolerant patient population.
This does not mean, however, that we allow nurses, with little to no administrative experience in managing a private office, or directing telecommunications, to head these departments.  I have seen nurses, working on their Masters degrees, trying to juggle the day to day administrative tasks of a medical practice and fail miserably.  There is a different skill set needed to be a brilliant nurse than there is to be a brilliant administrator.  Unless you are equipped with the complete package or are pursing a career in Health Care Administration, your nursing staff should move up the ranks in the areas of their special talents.

Our hospitals are soon to be judged and reimbursed on patient satisfaction scores.  It is time for us to stop believe our own press releases, and to bring our specific problems to the table and make sure that they are addressed.   In a large urban setting or a small community hospital there is certainly enough talent to carry us successfully forward into this uncertain future.  Less politics, more truth, and hard work are the skill sets we need to cultivate.

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