Physicians at JPS Health Network, Tarrant County, TX's taxpayer-supported public hospital system, are concerned that co-pays could be a barrier to patient care and has asked the administration to study their impact on the poor. The chairwoman of the JPS Health Network family medicine department has suggested finding a way to reduce co-pays for patients, especially for return test visits or when patients need ongoing treatments. Other physicians suggested that JPS use some of its surpluses to either reduce co-pays, waive them entirely, or find ways to group some payments together.
A mental health patient at Fort Worth, TX-based John Peter Smith Hospital died after the staff summoned an ambulance to take him to the emergency room instead of calling for doctors a little more than five minutes away. The ambulance took 15 minutes to arrive, and the hospital violated state law by its actions, an investigation by the Texas Department of State Health Services found. JPS' policy for emergency care at the psychiatric facility amounted to performing CPR and calling 911, and that was flawed, according to state investigators.
Last week, I wrote about some of the surprises I'm hearing in healthcare when it comes to recruitment and retention—sentences like "turnover is good," "signing bonuses don't work," and "we don't own our nurses." I heard a lot more about this subject over e-mail. Here's what readers had to say:
The med/surg unit should be a destination (not a rest stop). On the subject of "owning nurses," Kristen Baird, an RN and healthcare consultant, points out that external competition isn't the only competition hospital units worry about: "Medical/surgical units have not historically been a 'destination' unit for nurses, but rather the incubator for growing skills to better prepare them for other, perhaps more desirable units. The result is that nurses tend to work 1-2 years on these units and transfer into other areas that require previous med/surg experience. The managers of these med/surg units are in a constant flux and often resent the other departments 'stealing' their nurses. The system or organization may breathe a sigh of relief that the nurse didn't leave them for a competitor, but. . .often, the med/surg director is left scrambling to fill vacancies created by nurse transfers to other departments.
"This revolving door is nothing new, but we never seem to learn from this and haven't created processes and systems to allot for the short-term stint in med/surg and use it as a springboard to grow our future, expert workforce. As I see it, the issue comes down to a myopic view of departments as siloed business units with a finite allocation for FTEs. Wouldn't it make sense to proactively see the med/surg units as both a destination specialty and the training ground for specialties? If we can embrace this mindset, the med/surg units could be funded in part by education and development with FTEs designated as 'training tracks'."
"Stop promoting people!" As Val Kraus from Boulder Community Hospital writes, promotions aren't always good for the organization or the person being promoted. "The biggest thing that my facility is trying to do is stop promoting people just because they do a good job at the task level. I have had to demote individuals because previous people said, 'They are good at ________, surely they will be good supervising that group.' This is a painful process but should start decreasing now that we are setting up controls to hinder that."
"It's us, not them." I've written about bad leaders before, but one reader says it much better: "Most hospitals have leadership teams that have more in common with the dysfunctional parents on a Super Nanny show. The parents are upset with the kids but the reality is the parents are the problem. Unfortunately, the average hospital CEO would not tolerate a Super Nanny 'heart to heart' to face the brutal facts," wrote Daniel King, retired president of a St. Louis-based medical practice.
There's no denying that finding and keeping good employees is a hot topic, so please keep the e-mails coming. Let me know what you're doing, what works, and even what doesn't. And don't forget you can also read and comment online.
Molly Rowe is leadership editor with HealthLeaders magazine. She can be reached at mrowe@healthleadersmedia.com.
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To carry out their missions—and to maintain their financial viability—hospitals must ensure that they have the appropriate number and mix of physicians on their medical staffs. But the physician recruitment market has never been more competitive or complex thanks to the ever-growing list of service sites, problematic reimbursement, and an overall physician shortage. Finding and maintaining the appropriate physician mix is more time and resource intensive than it has ever been—but to what degree should the hospital’s chief executive officer be a part of the process?
CEOs cannot be directly involved in every stage of the process, but they also can’t take a completely hands-off approach. While delegating the legwork and logistics of recruiting, the CEO should:
Ensure a strategic framework is in place. Physician recruiting should not be an ad hoc endeavor initiated in reaction to an event such as a physician retirement or relocation. It should be a proactive process driven by an understanding of the hospital’s current medical staff and its projected needs.
The CEO should ensure that physician recruiters, medical directors, and others have a strategic basis for physician recruiting that is outlined in a formal medical staff plan. The plan should provide a portrait of the current staff, breaking down physicians by specialty, age, gender, and, through a medical staff survey, by practice characteristics, career plans and physician recruiting needs.
The staff plan provides a blueprint for current and projected staffing requirements. It also demonstrates to current medical staff through objective data the need to recruit additional physicians, addressing what can be a source of physician/hospital conflict.
During recruiting, the staff plan can help convince candidates that a real need exists for their specialty. The plan also serves as a compliance document since federal regulations require hospitals to justify their recruiting efforts on the basis of a demonstrable community need for new physicians.
Assemble the recruiting team. The CEO should assemble a medical staff development (MSD) committee to carry out the physician recruiting function. The MSD is charged with completing the medical staff plan or retaining a consultant to do so, creating physician retention programs, setting physician candidate parameters, developing incentive packages and contracts, sourcing candidates, reviewing CVs, conducting interviews, working with outside recruiting consultants, and assisting with candidate relocation.
The MSD typically will be comprised of five to 10 people, including a board member, a chief medical officer, in-house physician recruiters, and a mix of other hospital representatives such as the CFO and CNO, department heads and others. To be agile, the MSD must be able to vote with a quorum. The central figure on the committee, however, is the CEO, who is the final arbiter and decision maker regarding strategies, contracts, and candidates.
Create the optimal environment. Where physicians practice and how they practice is changing. The CEO must ensure the hospital has created a practice environment likely to meet the needs of today’s physicians, to both retain existing staff and to attract new doctors.
Tactics may include a shift to direct hospital employment of physicians, hospitalist and surgicalist programs, pay for emergency department call, physician/hospital joint ventures, gain sharing, and related strategies for enhancing physicians’ lifestyles and incomes.
In addition, the “workshop” is of primary importance to physicians. Efficient patient admission and discharge, quick turnaround of lab results, an adequate nursing staff, reliable access to operating rooms, even convenient parking are all workplace fundamentals key to retaining and attracting physicians.
Doctors today have many practice options. The CEO should objectively evaluate the hospital from the physicians’ perspective and take the steps necessary to create conditions likely to attract doctors.
Display the appropriate attitude. Success in physician recruiting is in large measure a matter of attitude. Who really wants available candidates more? Who is willing to devote the necessary time, resources, and energy needed to recruit doctors in today’s competitive environment?
CEOs can signal their commitment to physician recruiting success in two key ways: by being available and by being responsive. Despite conflicting priorities, CEOs should be accessible when key decisions in the recruiting process need to be made. They also should accommodate the interview schedules of physician candidates, which often mean weekend and night availability. Responding to candidate needs quickly—before misunderstandings or declining interest intervene—is imperative.
Perhaps most important, CEOs should display a sense of urgency about physician recruiting and instill a similar attitude in the recruiting committee. A sense of urgency and purpose is displayed through a competitive incentive package, aggressive candidate sourcing, a clear and readily available contract, and by an ongoing commitment to communicate with and respond to the needs of both existing medical staff and physician candidates. Physician recruiting today requires a responsive team approach. However, only the CEO can position the team for consistent and enduring success.
Mark Smith is president of Merritt, Hawkins & Associates, a national physician search and consulting firm and a division of AMN Healthcare. He can be reached at mark.smith@mhagroup.com.
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Mike Murphy, CEO of Sharp Healthcare in San Diego, describes how his organization used Baldridge criteria, Six Sigma, Disney consultants, and the input of unhappy patients to implement systemwide quality improvement initiatives. The quality focus also aligned the organization with emerging trends in the healthcare industry, including pushing providers and executives toward a greater focus on quality.
Although Michigan-based Henry Ford Health System made money in 2007, it was less than the year before as its cost of providing free care nearly doubled. The expense underscores the impact of unreimbursed care on hospitals caused by a loss of jobs and employee health benefits in the state, said Henry Ford representatives. The nonprofit Ford system earned $105.8 million in 2007, down from $134.9 million in 2006, on $3.47 billion in revenue, said Henry Ford President and CEO Nancy Schlichting.