“Two years ago, when nurses could get jobs anywhere and travelers were all over the place, people wouldn’t think about joining a union,” she says. “Today what is always important to us is to remember the value of the professional nurse in providing quality patient care.”
In terms of nursing environment, nurse-physician relationships are better than ever before. When asked to describe the relationship between nurses and physicians at their organizations, 80% described them as positive or very positive.
Interestingly, physician leaders had a similar take on the situation and 78% of both nurse and physician leaders reported relationships had improved at their organization in the past three years. Dohmann notes there has been a change in the industry. A few years ago, the problemwas widespread and not talked about.
Despite this good news, nurse executives revealed the damage caused by disruptive physician behavior is still an issue. Twenty-six percent said physician abuse or disrespect is pervasive at their organization. This indicates that the problem is still there and also backs up the fact that just one difficult physician can wreak havoc at a facility.
“Maybe we’re not where we want to be yet,” says Dohmann, “but we really have made strides and I think that what the survey reflects is the strong value in the nurse-physician relationship.”
Health Plans: Embracing ACOs
While health plan leaders generally are wary of healthcare reform and other changes occurring in the industry, they are optimistic about the outlook of their own organizations, particularly when it comes to accountable care organizations.
About 68% of health plan leaders responding to the 2011 HealthLeaders Media Industry Survey said ACOs will have a strongly positive or positive impact on their organization in the next three years, while just 6% said it will have a negative impact. Additionally, 44% said they will develop an ACO in the next five years and 24% said they already have the components in place.
“To me this suggests that survey respondents who are aware and believe these changes are coming, are embracing the changes,” says Deborah Gordon, senior director of marketing for Network Health in Medford, MA. “The relatively large neutral responses suggest to me that perhaps a segment of respondents is on the fence about whether [ACOs] will really develop into major trends or not. There was virtually no negative response to these—that’s great news.”
Despite many health plan leaders embracing accountable care, an integral component of healthcare reform, a majority is pessimistic about the new law.
About 56% of health plan leaders respondents said healthcare reform has financially weakened their organization and 42% think it will hurt the private insurance industry.
“I think that negative perceptions of health reform seem grounded in a general level of public confusion and fear of the unknown,” Gordon says. “We have had these developments in place in Massachusetts since 2006, and while not perfect, we have done a lot of good for the people in Massachusetts by expanding access to care and coverage to virtually everyone. The mandates, while not everyone’s favorite tool, definitely had a major impact on driving enrollments and balancing the risk pool. As such, they played a vital role, and I wish others could understand that.”
Healthcare reform may also be to blame for patient experience and patient satisfaction slipping from health plan leaders’ top priorities this year. About 38% of respondents to the 2010 survey ranked patient experience/patient satisfaction as a top-three priority for the next three years, ranking it second of 19 priorities. But 2011 survey respondents seem to have lost focus on the patient, resulting in patient experience/patient satisfaction ranking in seventh place with just 25% of respondents choosing it as a top-three priority. Cost reduction, care coordination, reimbursement, quality/patient safety, technology system/equipment, and developing an ACO each ranked higher than patient experience/patient satisfaction this year.
It’s ironic that healthcare reform changes may have swayed the realignment of health plan leaders’ priorities away from patient experience, because it is a key component to successful reform, Gordon says.
But there may be some positives in how health plan leaders intend to respond to healthcare reform.
About 62% of respondents said they are going to expand or create coverage options. About 40% said they plan to actively seek to enroll the previously uninsured, and about 28% said they will expand their own staff.
“I see real opportunity in this market,” Gordon says. “People are saying they’ll hire more people and create/expand coverage options. That should serve organizations and customers well, not to mention the potentially positive effect on the economy as this segment of the market grows and evolves.”
Rural: Priorities Differ from Urban Colleagues’
The hopes, goals, and worries that rural healthcare leaders carry with them these days are quite different than those on the minds of large urban facility leaders, according to responses to the 2011 HealthLeaders Media Industry Survey.
This year, respondents from rural areas put quality/patient safety as their No. 1 priority for the next three years, marginally upsetting the top priority from last year, physician recruitment and retention, which this year placed second, with 30% selecting it as among their top three priorities. Cost reduction, sixth overall last year, is tied with reimbursement as this year’s third-highest priority.
For nonrural leaders, cost reduction led the list, cited by 39% as among their top three priorities, followed by quality/patient safety (34%) and developing an accountable care organization (28%). Physician recruitment and retention is in tenth place, a top concern of just 13%.
But while physician recruitment dropped from being a top concern of 44% of rural leaders last year to just 30% for 2011, that doesn’t mean the challenges of attracting and keeping physicians is any less important, says Blake Kramer, administrator of Franklin Medical Center, a 32-staffed-bed hospital in Winnsboro, LA, which is a 45-minute drive away from the closest tertiary facility.
“Every physician survey you come across these days says physicians make a lot of lifestyle choices about where they go to work, and if you don’t have a movie theater or restaurants, or extracurricular or cultural activities, that translates to a doctor shortage.
“And if you do find a specialist willing to relocate, you then have to buy the equipment that specialist might need. For an orthopedic surgeon, for example, the investment in equipment up front is staggering. And electronic health records are a definite part of this, along with everything else.
“You have to spend money to break into the areas where reimbursement can be profitable or work the other side of the ledger and reduce costs.”
Another important issue weighing on the minds of Kramer and his peers at other rural hospitals, both in Louisiana and across the country, is the delicate balance between doing the right thing and doing the political thing in a smaller community, he says.
“The one other element that separates us from [leaders of urban hospitals] is the hyperpolitical nature of the job. In rural communities, you’re treating people you know, that know you, know your mamma and know your daddy. Care has to be personal, and of higher quality. And if it isn’t, it’s easier for them to approach the hospital governing body and staff with their concerns than it is for [patients and families treated at] a large urban medical center.”
For rural hospital executives, Kramer says healthcare reform seems to be “far off in the future” with so many other issues that must be tackled immediately.
“No one really knows how it will affect facilities like ours, and that’s a reason that many have put a hold on these ideas.” And whatever does happen, he says, “it’s probably not going to happen in 2011 or 2012 or even 2013.”