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How to Lead a Hospital to Better Outcomes

Philip Betbeze, for HealthLeaders Media, October 16, 2009

It's like dancing on the razor's edge, but I can't paraphrase what Anderson told me next about balancing the clinical case with the financial case any better than he said it himself.

"We thought that in conventional business terms that this would take cost out of the system. We made the argument that there was a great cost reduction opportunity. To all the business guys, that was music to their ears, but what none of us recognized is that the people you have to have doing it would understand the logic, but wouldn't necessarily change their behavior. Once we realized we weren't getting action, we decided not to talk about dollars anymore. Better outcomes and family experience was what resonated with docs and nurses. They thought we were just winking at that. We told them that actually, evidence-based protocols would reduce revenue and admissions, so we became credible on that issue. We were really in this for the outcomes."

So, what lessons can adult hospitals take from Cincinnati Children's journey? Again, Anderson says it better than I can:

"If I were leading an adult hospital, this has to start with the board and the CEO and they have to demand it and invest in it. Be willing to devote a disproportionate share of your time to making it happen. Without that, it's unlikely to occur downstream. The next piece is engaging on strategic planning to develop mission and action plans that embrace improved outcomes and value. Develop common ground with the broad organization. And lastly, you begin to invest in actions to make those things happen. Part of it is data collection and tracking. That's never been easier than it is today. No reason to reinvent the wheel there. Plagiarize them broadly and incorporate. Connect with organizations that are proven catalysts in transformational change. There are none better than IHI, which has lots of affordable mechanisms to begin to unleash this energy to improved outcomes, and then you follow the direction that's established by that preparation. Like Nike says, just do it."

Hamlin, the business guy in the room, anticipated my next question:

"How does that work when you're not in the tertiary business that can make up for more discipline by drawing patients from the outside to your tertiary programs? There are two choices. Let's say you are a community hospital that implements these and you take care of your community's population and it's not a growing population or it's shrinking. The principles are better utilization of the assets you already own, whether people or bricks and mortar. So now you've created extra capacity and you have two choices. Getting smaller and more profitable is a super win, but doesn't work in healthcare, obviously. So that excess capacity can be put to use for gaps in the community service that others won't provide. For us, we went into mental health. It's most underserved, it's not profitable, and it's not well received. Economics are such that no one wants to provide the service. We use what we've gleaned from our program to offer those services."

So no, it won't ultimately improve your finances. But it will improve your value to the community, and after all, if you're a nonprofit hospital, you're there to maximize the benefit to your community, right? Right?


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Philip Betbeze is senior leadership editor with HealthLeaders Media.
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