Love The Ones You're With

Rethinking. Freezing. Putting on hold. Resizing. Scaling down. Deferring. This is the current state of budgets, projects, and plans in hospitals across the country. Unfortunate? Absolutely. But also opportunistic. The economic climate creates a circumstance to look at what you have with new-found affection and care. Properly applied to people, technology, and facilities, this mindset should increase productivity. When I talk about loving the ones you're with, I'm talking about the machines and the buildings, but most of all, I'm talking about the people.

People first

While it's true that the macroeconomic environment will cause most employees to stay put, the most talented will be sought after and able to make very good deals for themselves. This scenario is always the case in turbulent times. High performers will look for challenge first, then visibility, while average employees will have security as their priority. So don't go around wringing your hands, hanging your head, and emphasizing what you can't afford to do. Focus on the elements of your situation that could be turned into a strategic advantage and get colleagues excited about it. Let your competitors be depressed. Let them moan about what they can't or don't have, while you remind each valued employee, colleague, and yourself, why you are confident because you are going through this struggle together. Attitude matters, and everyone wants to be part of a strong organization. Leaders are largely defined by their behavior in tough times.

Healthcare administrators often overlook the fact that physicians want to be affiliated with hospitals that are capable as well as enduring. This truism means that such hospitals have a vision, make decisions that move the organization forward and are on financially solid ground. Don't let your medical staff guess about what is going on or hear through the grapevine that employees are being let go or an intended purchase isn't going to happen. If you want them with you through and after the turbulence, step up the communication—both listening and conveying information. This is a great time to really communicate with them in whatever way is most effective: one-on-one encounters, town hall meetings, fact-filled broadcast e-mails, or all of the above. It may also be an interesting time to approach physicians you would like to get on staff and offer them the kind of transparency and insight they may not be getting from the hand-wringers across town.

Community matters

Don't ignore the community. The decreases in volume being witnessed are relatively small on a percentage basis. Worry less about who isn't coming in the door and more about who is coming in the door, ringing your phones, and visiting your Web site. If you haven't taken stock of those things in a while, now is an excellent time to do so with all patients and families, including donors. We all know the data about the impact of a tough economy on philanthropy. Don't take anything for granted. In this environment, the fact that healthcare organizations have reimbursement and other philanthropies don't can lead donors to minimize your need or believe their dollars will have more impact elsewhere. It is likely that you will need to do more this year, particularly in terms of personal appeals, to achieve the same level of giving as last year. And given the climate, this year's need is greater.

The tech relationship

Look at your current technology, both medical and information, as if you are at the beginning of a long-term relationship. Don't cut back on preventive maintenance: Expensive surprises aren't what you need right now, and run-down equipment sends the wrong signal to employees and can inspire unfortunate behavior—such as your employees calling the Occupational Safety and Health Administration. Consider a new level of scrutiny on what you need versus what is nice to have. Attendance at the Radiological Society of North America was down this year; some estimates by as much as 15%. Were the folks who stayed home wondering how to make things better or whining about not getting to Chicago? This is a perfect time to show the love for your medical technology by making sure it serves the organization to optimal advantage. If your elective procedures are down, has the staff in every department been visited lately? Maybe instead of telling callers when the next available appointment is, you could ask them when they would like to come in. The former advertises "fat and happy," the latter promotes the perception that the organization is friendly and values its patients.

Exploit efficiency

The diagnostic and treatment departments are a tremendous opportunity to exploit efficiency and a great patient experience. The outpatient encounters in imaging, cardiology, and GI are exponentially greater than the number of inpatient admissions. These services should be lucrative and provide several touch points for patients and families. Yet, the actual encounters often create bad impressions and therefore undesirable word-of-mouth. For many organizations, these conditions have not been objectively evaluated in quite a while. Perhaps it's a good time to talk a look at the services with a new perspective and ask:

1) Are we asking patients what they would like from us? In other words, do our scheduling and staffing patterns reflect the times most requested by patients?

2) Do we know how referring physicians feel about our service right now?

3) Are there cost-neutral things our competitors are doing to improve service or satisfaction that we should consider?

4) Do we have excess capacity in staff, technology, or space that could improve our financial performance?

Evaluate your IT

Most hospitals have IT capabilities they are not using. In many instances, they buy things in one system or application they already have in another. Complexity explains this phenomenon but doesn't compensate for the waste. Perhaps it's a good time to be certain you understand current information system capabilities, particularly in your clinical systems. The recession will not diminish the focus on safety and quality, and technology remains vital. Make sure you are demanding all that you can from investments already made, including the match between the information systems and the people responsible for them. There can be very pleasant surprises in systems optimization, although vendors may not agree.

Capital spending

Facility projects will be the largest hit to most organizations. Many projects that were well-justified and/or deeply desirable will not be constructed or are being revisited in terms of scope and timing. This is another potential blessing in disguise. Space is the least understood asset in most hospitals, which is peculiar because of its associated costs. Nevertheless, very few people have any notion of the real productivity or functionality of the space. As you look to make employees, physicians, patients, and families happy despite the new building being on hold, why not obtain an objective functional assessment of your patient care space and figure out which ones truly need attention versus areas where expenditure is unlikely to have a positive impact on your business?

Doing so allows you to prioritize short-term improvements and gives you insight for the longer term. In addition, such information can be very interesting for board members, employees, and physicians. Board members tend only to hear about facilities when someone is asking for big dollars to add more. They might be intrigued to hear that a capacity analysis reveals opportunities for better throughput and efficiency. Employees and physicians in conflict with their work space typically believe the answer is to get more. Often, convincing them to make better use of what they have comes from sharing information about allocation, functionality, and design using objective data. Looking at space across the organization is likely to reveal which services most need investment. Evaluating need and potential impact against financial capability streamlines decisions for the short- and long-term regardless of how much money is available.

As Horace said, "Adversity has the effect of eliciting talents, which in prosperous times would have lain dormant."