Jump . . . or Get Pushed

Carrie Vaughan, for HealthLeaders Magazine , April 9, 2009
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Shockney does concede, however, that if an organization's finances are just too poor and it wouldn't be able to make loan payments or keep critical indicators like days cash on hand in check, then it would have to postpone the project.

Convincing the board of trustees to take on this type of risk in light of the current economy is a whole different challenge. The top concern is that the project needs to fit in with the strategic plan. Executives also have to show that the organization will have the finances and future finances to do the project, that there is a community need for it, and how the project may impact other hospital services, Shockney says. If the organization is fortunate enough to have the cash and a board willing to take the risk, it is a buyer's market, adds Woodrell.

Bill Ott, a St. Louis-based senior consultant with Numerof & Associates, Inc., isn't convinced that large capital projects are where hospitals should be focusing their efforts. "You have to get out of big box mode. You need to think differently than asking for a lot of capital," he says, adding that there are different ways to save costs. For example, elevate expectations from managers. "We had a situation where length of stay related to people waiting an extra day or two for lab tests or MRIs. What is the department manager doing?" he asks.

Should we give more power to patients and families?
If you believe that patient empowerment is a soft decision, then you don't know what true patient empowerment really is. It's about more than a suggestion box in the lobby or a checkbox on the satisfaction survey.

One of the most transformative forces in healthcare today is the patient. Healthcare consumers are no longer willing to sit idly by while physicians make all of the decisions regarding their healthcare. They want more information about treatment options, quality, and price. They are also demanding more patient-friendly services. Hospitals that ignore this trend may soon find consumers forgoing their facility for a more patient-friendly institution up the road.

This may explain why consumer satisfaction ranked as the third highest priority behind quality and patient safety and physician recruitment, according to the HealthLeaders Media Industry Survey 2009, which surveyed 1,148 executives, including CEOs, finance, technology, marketing, quality, physicians, and health plans. Consumer satisfaction outranked construction and capital improvements and financial concerns like reimbursement, reducing costs, and revenue cycle.

The decision to pursue a more patient- and family-centered care model is not for those merely seeking the culture of the month. It requires an immense culture shift to pull it off. "This requires passion, commitment, reinforcement, and continuous education," says Bill Powanda, vice president of Griffin Hospital, which decided to change its organizational culture to a patient-centered, consumer-focused model in 1985.

Organizations need to determine how much access patients and families should have. For example, do you include them on hospital operating committees? Do you eliminate visitation restrictions and enable family members to be present during hospital rounds? There are risks. You could end up with a disruptive patient on a hospital committee, or physicians, nurses, and other staff members might rebel against the workflow changes required to provide a more patient-centered culture.

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