Massachusetts' largest hospitals say they have significantly cut the number of patients who acquire painful, costly, and sometimes deadly infections in their operating suites and intensive care units, suggesting that pressure from government regulators and patient groups, as well as a shift in doctors' attitudes, is starting to make medical care safer. Several academic medical centers in Boston said the number of ICU patients contracting bloodstream infections had dropped by at least half in the past several years because of new procedures to keep intravenous lines and other tubes cleaner. Hospitals also said they have reduced the number of patients on respirators who develop pneumonia. Beth Israel Deaconess Medical Center said so few patients now get this type of infection that the hospital was able to cancel plans to expand its ICU.
Despite the current economic downturn, hospital CEOs are actively recruiting physicians to their organizations, according to a new study.
Of the 284 hospital CEOs surveyed, more than half (54%) of them plan to increase recruitment efforts of physicians, according to "Clinical Workforce Issues: 2009 Survey of Hospital Chief Executive Officers" by AMN Healthcare, a healthcare staffing agency, in partnership with the research group, Council on Physician and Nurse Supply. In fact, the economic downturn actually has encouraged physician recruitment for some administrators; a quarter of CEOs boosted their efforts in the midst of the financial crisis.
When the rest of Americans are tightening their wallets, why are hospital CEOs loosening the purse strings to add physicians to their facilities? To fill doctor vacancies and to help the institution bounce back, CEOs reported.
Not like recession-proof lipstick
"We knew it was coming," said Kurt Mosley, vice president of business development of AMN Healthcare. "Healthcare isn't immune from the recession."
Although economic pundits recently declared that the "recession" is technically over because of increased nationwide spending, the current downturn has debunked the urban myth that hospitals would be invincible to the down economy.
Many once considered the healthcare field, like the cosmetic industry, recession proof, but that isn't the case, according to the survey. Hospitals that borrow from banks revealed an Achilles' heel, exposing themselves to the vulnerability of borrowing money, said Mosley.
"Hospitals showed that they are susceptible to banks and bonds that they weren't before," he said.
Shortage of physicians
On top of bruised hospital finances is the need for more physicians. Most CEOs believe there is a serious or moderate shortage of doctors that has especially worsened in the last six months.
"Shortages have always been there, and they always will be there," Mosley said.
Currently, there is a physician vacancy rate of 11%, reported CEOs.
With physician spots to fill and fewer patient admissions and procedures in hospital revenue, administrators are looking within to bounce back.
Regardless of the current economic state, "We are getting older, heavier, and living longer. It's a fact of life," he said.
And with older and sicker persons are patients in need of medicine.
"CEOs are tasked with taking care of patients," Mosley explained. Oftentimes, the physician vacancies are based on the community needs. For example, older populations might have a greater demand for cardiologists, and younger populations might demand family practitioners.
According to the survey, nearly all CEOs (99%) see physicians as important revenue drivers for hospitals. Out of all the healthcare professionals, most CEOs named physicians are the most important rainmakers, with the ability to draw in inpatient revenue from admissions and procedures, according to the survey.
Karen M. Cheung is associate editor at HCPro, Inc., contributing writer for HealthLeaders Media, and blogger for HospitalistLeadership.com. She can be contacted at kcheung@hcpro.com.
As the old saying goes: good people are hard to find. Fortunately—or unfortunately depending on one's point of view—good people are easier to find as a result of the Great Recession. While healthcare has not been hit as hard by the economic downtown as some market niches, our industry has not escaped completely and there have been job cuts. Whether from inside the industry, or as a result of career changes from other disciplines, in this bad economy we have the chance to find good people and bring them onto our teams.
The reason this is important is because whatever form healthcare reform finally takes, there is a call going out nationwide to improve the quality of healthcare. A higher quality of care means access to care, the ability to access that care more quickly and receive better service once care is accessed. The result, then, is improved patient outcomes. And all of this is achieved, hopefully, at a lower cost.
Much structural reform is needed to get to higher quality healthcare. My experience is that in the end it's people who make the difference. Good people, whether partners or employees, bring more than technical expertise. They bring a conscious, intellectual and emotional commitment to their job. To earn that commitment and in turn reward it requires a values-driven environment that nurtures people, rewards their commitment and ultimately drives to a visualized and clearly communicated goal of high quality care and improved results for patients.
A good example of a values-driven culture is Southwest Airlines.
Southwest instills its culture from the executive level down to new hires. Simply, the airline delivers great service; it's on time and offers customers low fares.
The carrier is known for its quick execution. The most common example is the airline's ability to turn around a plane in 20 minutes from the time it arrives at a gate to when it departs next. Some things are beyond its control, but the success of quick turnaround has given Southwest its legendary competitive advantage.
Southwest's dedication to quality is reflected in its use of technology. The most easily recognizable example is the replacement of old aircraft with new aircraft to improve performance efficiencies and passenger comfort.
Translated to healthcare, quality and value means buy-in across an organization-wide to a values-driven, patient-focused culture with its ultimate goal of superior care. It means looking at how we execute and seeking to do it more efficiently without losing our humanity. It means learning that we don't embrace the use of technology for technology's sake; rather we use it where the result is better care at lower cost.
We all have the opportunity to create a values-driven culture that results in a positive, welcoming, healing environment for patients that delivers high quality care. We have found that we can create this culture by:
Treating patients, their families, and each other with respect. Make the patients feel cared for. Pay attention to their concerns. Do the same for colleagues and peers. And do it every time.
Living and demonstrating integrity. Do what we say we're going to do. Stick to our commitments and abide by our organization's structure and guidelines. And abide by the laws and regulations that pertain to our industry.
Communicating with the patient, with the patient's family and with each other. Act quickly on requests, whether from patients, from physicians or from each other—and always follow up. Survey patients, get their feedback and act on the information they provide. And do this with consistency.
Being efficient. Time is precious. Yes, it's money (another old saying), but it is also finite. We only have so much of it. Plan and prioritize and then follow that plan. Ensure that you are using the organization's technological resources wisely, acquiring new technology when appropriate, not just because it's the latest thing. Use the other resources offered by the organization and your peers efficiently and effectively.
We created a values-driven, patient-focused culture based on the steps I have just described. Using a formal process, it helped establish the guidelines and metrics to create an inclusive, patient-centric environment and measure our performance and how to improve it. The result is a healing environment that also nurtures our staff and clinicians while delivering the highest quality care to patients.
It is possible to create a values-driven culture within your organization, but a reminder that it must be driven from top down. The entire management structure must buy in if the staff is eventually to buy in. If you are partnering with other facilities or physicians, you must make certain that they share your vision and determination to incorporate, nurture—and push from time-to-time—a values-driven culture.
With metrics in place, you'll be able to measure performance and success. Frankly, though, you'll know it before any metric confirms it. You'll be able to physically see it in the day-to-day operations, in how people behave and perform—and in how patients respond. Of course, once such an environment is achieved, you must perpetuate it by keeping to the fundamentals that helped you create such an environment.
My experience is that when we create a better environment for our people and our patients, the results are happier patients and patient families, and happier staffs that perform at higher levels. Certainly it's more than just everyone being happy. Such a total healing environment helps patients recover faster and leave the hospital sooner, which lowers costs. Improved patient outcomes translate into higher patient satisfaction—and of course most important, a patient's return to health.
Finding good people is hard. Keeping them requires our dedication and continuous effort regardless of the economic conditions. Yet the lessons can be applied across the industry. Investing in our culture and living to a higher professional standard every day results in retaining a committed, happy staff. Most important: it creates a healing environment that delivers the very best in patient care and provides a lesson for healthcare reform.
Tom Mallon is co-founder and CEO of Regent Surgical Health, which works with physician and hospital partners in the development, management and turnaround of surgery centers and specialty hospitals. He may be reached at 708-492-0531.For information on how you can contribute to HealthLeaders Media online, please read our Editorial Guidelines.
As Senate Majority Leader Harry M. Reid worked to nail down the votes needed to move to a final debate on healthcare legislation, a tepid assessment of the public insurance plan he crafted emerged as the latest potential obstacle to its passage, the Washington Post reports. A Congressional Budget Office analysis of the scaled-down public plan that Reid included in his $848 billion measure said it would have relatively little impact on the current system, would charge "somewhat higher" premiums than its private competitors, and would draw only about 4 million subscribers.
The House has approved a $210 billion measure to avert steep cuts in Medicare payments to doctors. The legislation, known on Capitol Hill as the "doc fix," would prevent a 21% cut in Medicare payments to doctors set to take effect in January, and also prevent further cuts in the years ahead. The bill seeks to correct a flawed payment formula that stems from earlier legislation intended to control the steep rise in Medicare costs. But Congress has stepped in repeatedly in recent years to avoid the cuts to doctor payments, the New York Times reports.
The Senate is expected to vote Nov. 21 on whether to take up health legislation that would cover five million fewer people than a companion bill passed by the House, but would cost less. A major difference between the bills is the effective date for important provisions, like the requirement for people to obtain insurance and the obligation of employers to help pay for it. Many provisions of the House bill would take effect in 2013. But to help hold down the cost of the bill, Senate Majority Leader Harry Reid decided to delay the effective date for many provisions by one year, to 2014.