By Jeff Goldsmith
Jeff wrote this article for hospitals and health networks in the edition of July 5, 1998. He published it again in his replacement by calling him a “27th Anniversary edition.” It is an enlightening piece, but while read, please ask yourself. What, if something, has changed and improved something? –Matthew Holt
It is difficult not to be impressed by the scanning of change, both in the capacities of the US health system and in medical care organizations, in the last 20 years. In the single -generation space, health services have evolved from an artisanal industry to a substantial corporate company. An impressive variety of new technologies to the diagnosis and therapeutic capacity of the hospital has been added. Hospitals have also managed, although not always with grace, the transition to a more ambulatory and community care model.
Through all these changes, the hospital has remained a central actor in the health system, and despite the periodic political challenges, its economic position has a significant force. But this success has reached a terrible price: the growing alienation of professionals who are the soul of medical care and who have most of the moral risk of medical care transaction.
As organizations have been structurally integrated, culturally disintegrated. Not only doctors, but also nurses, technicians and social workers have been transformed into products and marginalized by the corporate spirit of health services. Professional discontent has intensified as medical practice has been increasingly incorporated into the hospital already measure that health systems have begun to rationing care through captive health plans.
The abyss between managers and professionals, and also among senior and a half management, has expanded in an abyss. In its maximum financial strength and in the midst of a record economic expansion, the field of health has become mature for unionization. In fact, the work environment among health professionals has become so hostile towards management that the organization of health services could revive without help the trade union movement in the United States.
Part of this tension is a pressure byproduct to reduce the excess hospital capacity that health systems have inherited. Moving from the current concentration of property to the consolidation of excess capacity will inevitably mean reductions or reasoning of the workforce. The fact that a small real reduction in the hospital workforce capacity has taken place so far does not mean that the pressure to reduce jobs and improve productivity is not real and tangible, or that it gained in the future.
But the origin of the problems of the workforce in hospitals and health systems is deeper than the pressure to consolidate. In little more than a generation, the management of hospitals has gone from a passive tradition, custody and largely benign to an aggressive and growth -oriented business management framework.
It is difficult to dispute the economic success of these growth strategies. Since 1978, the net revenues of hospitals have increased almost five times, from $ 71 billion to more than $ 350 billion. Despite the challenges of administered care, hospital profitability rose to a record level in 1997.
At the same time, operations, the critical interface between technology, professionals and patients, have tasks in the rear seat to do business and “positioning” in relation to the care administered in most executive suites. This migration did not happen overnight. Around the last two decades, in breathless sequence, hospitals have reorganized, diversified, consolidated, “integrated”, built regional medical care networks, evolved vehicles of captive fine and incorporated a wide range of new technologies.
The resulting modem company is large billion. The health systems, without realizing, have grown to the point where both the patient and the caregiver who must work within them. As powerful as their abilities are, many medical care companies have grown beyond the human scale and have lost their focus on the daily struggles of life and death that occur within their walls.
The growth approach has also led to a failure in the development of the culture of operational excellence necessary to manage reflective, efficient and Saafely health systems. Only health service researchers have begun to count the cost of using our increasingly complex health system.
In the 20 -year adjustments, the hospital nosocomial infection rate has increased by 36 percent. Up to 180,000 Americans in hospitals every year of causes related to treatment, and approximately half of those deaths are prevention. It is believed that advertising drug reactions kill 100,000 patients a year in USHOSPITALS. In many metropolitan areas, there is a variation five times in the risk of mortality for common surgical procedures, given the capacities of our health system, the human cost of using it is an unacceptive fable.
Most Americans understand Neinder the magnitude or the type of risk they run. They believe that an invisible force, the government, Perhapshas created a uniformly high quality standard that protects them when they use the health system. But the illusion is dissolving, replaced by consumer surveillance.
The variation in the quality provides a wonderful strategic seque for care companies under siege to allegedly interfere with the practice of medicine and the quality of harmful care. The best way for health plans to change their image of consumers adversaries to defenders is to become “transparent” to substantial quality and cost variation in the nations medical care system. By granting patients, both information and economic incentives to select the highest value suppliers that represent the lowest risk, managed care plans can help families make intelligent use of the choice they have demanded.
Domain medical care operations and instill a continuous improvement of clinical quality can provide the missing critical ingredient in health systems. The operational excellence of boat is the next logical step in the evolution of health system management. Creating an intolerant culture to an avoidable systemic medical error and establishing a collaboration framework to define what constitutes the best medical practice will help reintegrate professionals and managers, specialists and suppliers of primary care, supervisors and caregivers.
After all, as all age, they inevitably use the health system. The efforts to achieve a high standard of excellence will have measurable benefits for individual patients and for society in general. Executives of the Hospital and Health System privately applaud the increasingly hostile vision of the public of administered care, but cannot see that the same brush rents them.
The American people do not like the new corporate face of medicine. They do not distinguish between profit and non -profit medical care or, surprisingly, between administered care plans and suppliers conglomerates. Americans believe more and more than money, do not meet their attention needs, is the driving force of the new medical care company.
This is not an image problem. It is a reality problem. Addressing it should be an urgent priority for medical care managers and trusts. Large and small medical care companies are community health administrators. Restoring a human scale and human values to the health system is vital for those who manage our health companies. Unless these companies can organize to provide a measurable value to consumers, and less that managers can unify their organizations to improve the lives and well -being of those in their communities, the revolution of management in health services will result in short duration.
Re -connect with health professionals and reconcile professional and management values within hospitals and health systems are the essential conditions to create a safer and receptive health system.
Jeff Goldsmith is a futuristic veteran of medical care, president of Health Futures INC and regular THCB taxpayer. This comes from your Personal subck