Like St. Vincent's Hospital in Manhattan, North General hospital in Harlem is trying to restructure itself to avoid closing and has reached out to potential partners and New York state for money to keep going, industry officials said. Its closing could be a boon for hospitals on the borders of Harlem: Although North General serves a large number of poor and uninsured patients, it is also perceived as a destination for middle-class Harlem residents. The industry officials said one possibility was for a rehabilitation center operated by New York City's public hospital system to take over at least part of the North General site, the New York Times reports.
Chicago-based real estate firm Lillibridge is developing three outpatient facilities in Winter Park, DeLand, and Deltona for Adventist Health System's Florida division. Lillibridge is building a two-story, 36,000-square-foot medical office building on Florida Hospital's Winter Park Memorial Hospital campus. In DeLand, construction began this month on Victoria Medical Park, a one-story, 24,000-square-foot health center near Florida Hospital DeLand. In And in Deltona, Lillibridge plans to begin construction later this year for a one-story, 30,000-square-foot, medical office building near Florida Hospital Fish Memorial in Orange City.
Philadelphia-based Girard Medical Center will lay off about 100 people April 24, a few days after it permanently closes its Continuing Care Hospital, according to a notice filed with the Pennsylvania Department of Labor and Industry. Girard Medical Center is part of the North Philadelphia Health System. The medical center is a 168-bed long-term acute-care hospital.
Looking into crystal balls and performing balancing acts aren't just the work of circus performers. They're also great skills for medical staffs to exercise.
For example, being able to predict practitioner placement trends in your medical staff can help you budget for enough FTEs in your medical staff services department, update privileging forms before a new wave of specialists arrive, and prepare for a shift in medical staff culture.
The Delta Companies is one organization that can help your medical staff plan for the future. Delta is a practitioner placement group that publishes free, quarterly resources providing summaries of physician and healthcare specialist compensation, placement data, and market trends in recruitment.
The quarterly reports provide a snapshot of the current healthcare environment, but analyzing several reports at once can help identify trends. "If you look at three or four [reports] over a period of time, I think that gives you a good indication of what trends are beginning to occur and what trends are starting to decline," says Shannon Penney, director of recruiting at Delta Physician Placement, in Dallas.
Forecasters see several noticeable trends around the country that can potentially affect the work of the medical staff. For instance, many specialty surgeons are staying put and not transitioning out of their current medical staff placements, says Penney. "With an economic downturn, that stops retirement, [surgeons aren't] as likely to retire, they'll stick it out another year, another year and a half to pad their retirement," Penney says.
Specifically, Delta has seen a decline in the need for cardiac surgeons. "Any form of cardiac surgery has been on the decline with the advances in cardiac medicine," he says. "From the pharmaceutical standpoint, many things are controlled by pharmaceuticals rather than corrected by surgery."
Although the need for surgeons is down, Delta did see an increase in cardiologist specialist in general. Cardiology ranked 10th on a list of the most requested searches initiated by Delta Physician Placement in the fourth quarter of 2008. Compare that with a fourth place ranking for the same quarter in 2009.
Delta isn't the only organization watching the growing cardiology trend. The medical staff service professionals at Scripps Centralized Credentialing Service are anticipating an increase in applications from cardiologists, but for different reasons.
"Scripps has implemented the first phase of a cardiovascular institute," says Maggie Palmer, MSA, CPMSM, CPCS, director of Scripps Centralized Credentialing Service in San Diego. "That is going to take on a whole new face for us and we've seen a rise in the fellowships in cardiovascular disease."
Another regional trend that Palmer has seen is in the rise of perinatologists. "That trend is growing to provide 24-hour care, kind of like hospitalists, but for labor and delivery," she says.
San Diego has a need for more labor and delivery practitioners because it is a town with a lot of young residents; however, the need for those services follows a particular cycle. Because there is a large military population in the city, hospitals see an increase in births after deployments.
Trends can showcase declines as well as increases. "One decline we've seen is anesthesiology and one of the reasons why we've seen a decline is because those spots are being filled by CRNAs," says Penney. "In most climates, they're overseen by an anesthesiologist so you may have one anesthesiologist and four or five CRNAs who can take the place of an anesthesiologist."
Perhaps one of the most important tips to remember when tracking practitioner trends is to observe national trends, but never forget the particular needs and interests of your local patient base.
By watching trends and taking actions based on those findings, hospitals can have more control over their work flow and improve budget management.
Physicians attribute 26% of overall healthcare costs to the practice of defensive medicine, according to a study released by Gallup and Jackson Healthcare. Of the physicians surveyed, 73% agreed that they had practiced some form of defensive medicine in the past 12 months. Twenty-three percent of practicing physicians estimate that defensive medicine constitutes less than 10% of their practice while 29% estimate the percentage to be between 10% and less than 25%.
We have all heard the latest success advice for healthcare providers—make care more patient-centric care and consumer-driven, and improve the service experience quality. We have also heard the usual justification: These concepts are needed to effectively compete in the "new" healthcare marketplace.
While it's clear that healthcare organizations have a great deal to learn from other service-focused businesses, the most pressing reason isn't to outshine competitors. Rather, it's to ensure our healthcare delivery system accomplishes its primary goal—the effective treatment of acute and chronic conditions.
Research shows that the quality of healthcare outcomes is almost always directly tied to the level of patient compliance. What many healthcare organizations fail to realize is that understanding consumer decision-making and patients' expectations regarding communication, engagement, and education can lead to greater patient compliance and therefore better patient outcomes.
Lessons from Marketers
So how do healthcare leaders leverage knowledge about consumer decision-making and expectations to change patient behavior? They do what product and service marketers do every day—engage consumers through effective communication in an effort to educate them on the benefits of the marketer's product or service and influence their buying decisions (i.e., change behavior).
To reach consumers most effectively, marketers look for common traits or values within their target audiences. They then segment consumers along these common traits and build their communication or marketing strategies to appeal to the targeted consumers in ways that have the best chance of changing behavior.
The Generation Gap
If healthcare were to use these strategies to enhance the engagement and education of the targeted segments of patients, thereby improving compliance and patient outcomes, what would it look like?
As an example, consider how four generations interact with the current healthcare system. Typically classified by birth years—Greatest Generation (1925-1945), Baby Boomers (1946-1965), Gen X'ers (1966-1985) and Millennials (1986-2005)—each generation's expectations are defined by common experiences such as societal changes (wars, economic boom or bust, cultural shifts), institutional responses (government's handling of societal changes), technological advances, and accepted workplace attitudes.
How the generations view healthcare is no exception
Greatest Generation: Direct Me
The Greatest Generation grew up believing in the value and effectiveness of large institutions and the credentials of the individuals leading these institutions. This generation weathered the Great Depression and saw the government's economic intervention carry the country through this tragic period. World War II was viewed as an honor to serve and protect the country that had worked so hard to right itself economically. This generation looks to the healthcare system to provide specific direction and support.
Baby Boomers: Engage Me
Baby Boomers were raised in a period of incredible economic prosperity. Social norms shifted enormously: racial riots over equal rights, the sexual revolution, and campus protests led by focused individuals all combined to forge a generation that believed the world could be changed if you worked hard enough. Thus, the generation of workaholics was born. Institutions were not to be blindly trusted. The administration lied about its handling of the Vietnam War; people were beaten and jailed for being different racially or philosophically, prompting the credo, "Don't trust anyone over 30." Boomers expect the healthcare system to be a two-way interaction. They want to be involved in the decision making and will bring their own perspectives to any discussion.
Generation X: Educate Me
Members of Generation X were the "latchkey kids" of the workaholic Baby Boomer parents. They learned to prize independence and self-sufficiency, although they place a high value on peer-to-peer interaction. They reject the workaholic approach of their parents. Gen Xers seek balance in their lives between work and family, and they often view large institutions and formal organizations with disdain. This generation considers healthcare a personal responsibility; they are looking for the healthcare system to support their drive for independence through education regarding their family's health.
Millennials: Connect Me
Technology has become an extension of their very being. Texting is the preferred mode of communication (even when they are sitting next to each other), and Facebook and Twitter capture every detail of their lives, allowing continuous connection with their cyber community. They expect the healthcare system to replicate this level of ubiquitous access.
The Value Proposition
Much of the current healthcare system is structured to meet the expectations of the Greatest Generation, designed to establish provider authority and drive patient compliance through direction and one way communication. Historically, this approach worked because it is consistent with the values of the generation it was designed to serve. However, this structure is out-of-date for the majority of patients providers are now facing.
Baby Boomers are looking for a system that provides two-way communication and shared decision-making. They want a provider to engage in a discussion of the treatment regimen and they are looking for options or alternatives. Be ready to engage in a dialogue with these patients. Listen to their input and validate that these patients agree with the treatment regimen, not just understand it. Adjusting to this expectation becomes especially relevant because Boomers are not only accessing the healthcare system more frequently due to their advancing age but are also serving as the decision-maker for their parents' healthcare needs.
As the younger generations (Gen Xers and Millennials) increase their personal and family usage of the healthcare system, their service expectations are being addressed by innovations in healthcare delivery like retail health (e.g., CVS/MinuteClinic). Gen Xers want to be educated on how to better care for their families. They value their independence and do not respond well to heavy-handed, directive providers.
With Generation X, providers should seek to establish an understanding of why a regimen is being employed. Find ways to educate these patients on what caused the condition and how to avoid recurrences as well.
The Millennials are looking for a healthcare experience that is more consistent with the communal support and technology-based access they experience in their personal lives (online appointments, texting treatment reminders, e-mail responses to questions, etc.). This generation seeks providers who understand the appeal of communal sharing. In response, some providers are creating professional Facebook pages and blogging as a way to inform their patients about current and upcoming health concerns or treatment options.
Accepting that the secret to greater quality outcomes in healthcare is improved patient compliance and this improved compliance requires behavioral change on the part of the patient, then understanding the differences in how the patient prefers to interact with the healthcare system should be the goal of every provider. As such, today's providers can learn a great deal from other service-minded organizations outside of healthcare that are successfully meeting these changing expectations driven by the newer generations.
Michael C. Howe is the former CEO of MinuteClinic, the largest retail health organization in the world. He is an expert on consumer-driven healthcare and an authority on helping healthcare leaders translate lessons from outside industries to better the continuum of care.For information on how you can contribute to HealthLeaders Media online, please read our Editorial Guidelines.