Our Annual Industry Survey: The Challenge to Collaborate

This article appears in the February 2012 issue of HealthLeaders magazine.

Until you identify the source of a problem, you are not likely to develop a solution. A common theme that runs through the results of the HealthLeaders Media Industry Survey 2012 is collaboration—the need for it and, too often, the lack of it.

This fourth annual offering—through survey data and analysis of that data by healthcare leaders themselves—reveals the targeted priorities and concerns from within the industry's C-suite. The comprehensive project, conducted by the HealthLeaders Media Intelligence Unit, breaks down the results into multiple reports that explore issues of special interest to finance, physician, nurse, and senior leaders. We drill down further in reports that focus exclusively on CEOs, community and rural leaders, and service line revenue growth.

The Overall Cross-Sector Report shares the thinking of nearly 1,100 of your peers in the industry: senior leaders at hospitals, health systems, physician organizations, and other provider and payer settings. Together, they offer a unique look at the state of the healthcare industry and where it is heading.
Consider:

• A significant majority, 59% of healthcare leaders, cited "too much self-interest among the different stakeholders" as the reason the healthcare industry cannot solve its own problems. The next-highest response (14%) was "lack of incentive to innovate or deliver value."
• So who's going to save the healthcare industry? No single actor or group can succeed, according to our survey—the single greatest response to this question (31%) was "other," and the written comments reveal that most believe it will take a collaborative effort among all elements of the industry to fix things. Next in line to save the industry, respondents say, are hospitals (22%), government (12%), and physicians (11%).
• It may come as little surprise that the single biggest culprit for the healthcare industry's mess is the government, cited by 40% of respondents. Health plans get the blame from 22% of respondents, but an equal share, 22%, chose "other," and the written comments reveal a belief that all stakeholders must share the blame.

Healthcare leaders aren't sanguine about the current direction of the industry. Only 25% describe the healthcare industry as being on the right track, with 46% saying it's on the wrong track and 29% undecided. People are more positive about their own organizations, however; 66% say it's on the right track, with just 12% saying wrong track and another 21% undecided. Even so, that right track figure is down from 72% in last year's survey.

Coordination strategies
The absence of and the need for collaboration is seen in questions that explore not just the business of healthcare, but its clinical aspects as well.

• Care coordination and continuum of care represents the single greatest strategic challenge for clinical quality improvement, selected as top choice by 25%. Second choice, at 21%, is improving patient experience, including patient flow.
• Only 14% of leaders say their organization's care coordination is "very strong." Yes, 45% rate it as being "strong," but one-quarter (24%) can muster only a "neutral" rating and 17% cite it as being "weak" or "very weak."

More than half of respondents see accountable care organizations as worth pursuing, with 53% saying that their organization will be part of an ACO within the next three to five years.

Internal imperatives
Perhaps ACOs can help reduce some of the tension that exists between payers and providers. But providers still have some challenges within their own ranks that suggest a need for greater collaboration.

We asked both physician leaders and nurse leaders to assess how pervasive physician abuse or disrespect of nurses is at their organization. There is a clear disconnect in their perceptions. While just 13% of physician leaders say those conditions are common, more than three times that number—42%—of nurse leaders see it that way.

We explore that disconnect in our Physician Leader and Nurse Leader reports, but comments offered by respondents provide some additional insight.

A physician leader who says physician abuse or disrespect of nurses is uncommon offers this: "It's the other way around. Nurses don't respect the physicians."

One nurse leader who says disrespect is common notes that leadership can do only so much, and that the nurses must be more willing to speak up. "While we have a robust disruptive physician policy and follow-up, actions require knowledge of events, nursing remains hesitant to report, as do other disciplines."

Despite the industry's enormous challenges and demands, bright and dedicated people continue to devote their careers to healing and helping, and 81% of the survey respondents say that, overall, they are satisfied or very satisfied in their job.

Clearly, individuals should feel positive about the work that they do, but they also need to feel good about their profession. The survey suggests considerable room for improvement in the area of collaboration. Given the complexity of clinical care and diversity of business interests, achieving that cohesion will not be easy—but no one enters healthcare because it's easy.

As one nurse leader puts it: "We will only fix this when we stop blaming and decide to collaborate as a system." What no one knows is whether industry leadership will come together and address these challenges before, as one senior leader ominously puts it, "We must hit bottom first."

This article appears in the February 2012 issue of HealthLeaders magazine.