Excerpted from a presentation to the VHA/SW Annual Trustees Conference
I believe we have reached the point in health-care delivery when the trajectory of culture, economics and technology are colliding to compromise the care of patients. You are all familiar with struggles: constantly changing legislation and regulations which make it hard to stay in compliance; new technology is changing the way we do business; the impact of managed care; and decreasing reimbursements all challenge our survival. You are non-profit community hospitals whose mission and charter is to address the needs of your communities. How are you going to deal with these issues? How will you absorb the costs of the uninsured, which accounts for 25% of the population in some states? In the old days, paying patients would cover those who couldn’t pay, but this is no longer the case.
Community hospitals, and especially teaching hospitals, are laying-off workers, rationing care to the uninsured, even selling control to “for-profit” companies. Competition for scarcer resources does not breed good neighborliness; as physicians, administrators, and trustees we are increasingly struggling among ourselves. Doctors are feeling that their clinical judgments are being subordinated to fiscal considerations. In order to do right to by their patients, doctors feel it necessary to play games with insurance companies. Forty percent of 720 doctors interviewed in an article in the April 12, 2000 issue of the JAMA said that they exaggerated illness, changed diagnoses, or otherwise “gamed the system” in order to do what was best for their patients. Lots of doctors are leaving practice and many say that they would have chosen a different profession if given the chance to start over.
Administrators are saying the same things; fiscal restraints are forcing compromises. They cannot buy every orthopedic appliance known to man or every new machine. With everyone struggling to preserve income and territory, we are no longer sure we have each other’s best interests at heart. It’s creating an environment that is dividing us and threatens the foundation of our profession. We cannot allow this atmosphere of dissention to divide our communities and our values. We must remind ourselves what we stand for, and that’s a sacred obligation to heal the sick.
The first thing we need to do is stop blaming everybody else for our predicament. Pointing the finger of blame is a narcissistic response that creates fear and division. We need to find ways to come together openly and honestly if we are to sustain a healing community. We can’t all have it our way, so we need to set some limits that we can all live with.
Unless we maintain our faith and trust in each other, we will never be able to address the new pressures that the technologic age and genomic revolution hold in store for us. This is how the future looks: surgeons will be able to operate remotely; altered chromosomes will eliminate some diseases and create new ones; transplanted organs will be cloned, and as a species we will be growing older. How will you sustain community hospitals when patients will be able to get Internet advice and treatment from experts geographically far removed? I believe it is by inspiring their faith and trust in you. Opinions will always differ; surgeons in Boston recommend a different type of back surgery than do those in Seattle for the exact same pathology. Patients can get as much information as they can handle; the task in today’s environment is not getting more information, but getting help processing that information. Community hospitals and physicians will always be relied on because our patients still trust us. Health outcome studies show that improvement in a patient’s health is most directly correlated to the patient’s trust in their hospital, their physician, and their physician’s knowledge of their home life. We must sustain that trust, which is our cause and calling. Our patients will stay with us if they have faith in us and know that if what they need exceeds our capacity we will refer them elsewhere.
These are my recommendations for how to ensure our success.
1. Lighten up. Find more ways to love what you do. Get connected to things that bring you joy everyday.
2. Be open. That means going away on retreat somewhere and sharing your strengths and weaknesses, successes and failures. No finger pointing. The more we come together, the more ideas and solutions will come about naturally. Focus on problem solving and you will create unity.
3. Take risks. Even if the venture doesn’t work out, successful innovation is built on trial and error. The way it was is not the way it is.
4. Use technology. Get an Internet presence, share information but not at the expense of sacrificing personal relationships. We must stay connected to each other and to our patients. High touch is as important as high tech. The huge rise in the cash business of Complementary and Alternative Medicine (CAM) is a statement that people want more hands-on, personal attention
5. Think generationally. We are now thinking quarterly in the language of balance sheets. When the bottom line compromises care we will become just another industry. Healthcare is a ministry and we must look ahead to twenty years from now, and know that we have retained our fundamental values. Remember your mission and advertise it
6. Establish coalitions. Make relationships with others who can complement your services. Nobody makes it alone. Build a community of support, away and at home. Remember the lives that place themselves in your hands and believe in you, and go with joy on our shared healing journey.