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In short, a decentralized reporting structure for the four-hospital system had the unwanted effect of creating silos, which—although they were accountable and achieving hospital goals—weren’t achieving system or community goals. Critically, the decentralized structure created “enormous” variation in practice, Van Gorder says.
Variation, of course, is a huge negative as healthcare reimbursement moves from volume- to outcomes-based, which is why Van Gorder and his board decided that the hospitals at Scripps needed to act more in concert—that is, as a true healthcare system, not a confederation.
Van Gorder says part of the impetus for the reorganization came to him while he and several other hospital executives and physicians were in Haiti after that country’s devastating earthquake last year.
“When we were on our Haiti mission, we stayed in the papal nuncio’s compound, sleeping in the courtyard, which overlooked Port Au Prince, [the Haitian capital]. As we looked out over the city, it looked absolutely beautiful,” he says. “Very much like our organization was structured. It looked beautiful from my vantage point. But from my perspective, I knew it was not a structure that could service us in the future.”
The inspiration led to a revival of the centralized approach to responsibilities within Scripps, but with a few twists from the action that caused the physician revolt more than a decade ago.
“We decided to move away from this silo approach to much more horizontal approach,” he says. “Isn’t it interesting that where you stand affects your view of things?”
Van Gorder began immediately to envision what kind of structure he wanted and came up with what he calls a matrix, which was implemented in fall 2010. What it means is that Scripps now has a horizontally focused—that is, systemwide—operations executive for every function in the system.
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