I Choose the Size of the Needle

The healthcare system is fraught with challenges — ranging from disruptive technologies and reimbursement complexity to price and cost obstacles, as well as pressure from government, insurers and businesses. It often appears from our vantage point, healthcare executives embrace a “sky is falling” mentality to reducing costs initiatives, though reality doesn’t always follow this perspective.  Pressures continue to mount and the industry is increasing in complexity while hospital administration is hell bent on extending those pressures to cut costs and increase efficiency.

We see clinicians and administration tackling these issues as best they can together to uncover new ways to reduce expenses while better serving patients. Effective collaboration mandates breaking down existing biases and building a culture of trust — centered on enhancing patient care. Sounds great in theory without any element of stress, right?

Sure, and it’s contingent, however, upon leaving your preconceived notions and ego at the door to re-establish and build an open collaborative environment verus the traditional controlling confrontational landscape we’ve seen for far too long. Hey! We’re not enemies.

Let’s dive into the meat-on-the-bone of it: To create a more collaborative culture, hospital administration and clinicians must break down three biases that are blocking sustainable change to move forward as an organization together in one direction.

Conflict and Tension are Detrimental to Success

The polarity between hospital administration and clinicians can foster a healthy dialogue inspiring innovative problem solving to enhance patient care, reduce costs and improve efficiency. Conflict is not always a bad thing! It’s an opportunity to listen and uncover objections, to gather new or more information to a recurring problem that may have been stagnant or the redundant, ‘this is how we always do it.’ Isn’t it time to try another tact to an age old problem. How about sharing a new mindset of, ‘this is how we’re expected to do it.’ Let’s communicate more often, solve our problems together and see how we can systematically ensure we’re not repeating the old ways of inefficiency again and again.

Despite the differences, clinicians and hospital administration must eliminate the US versus THEM perspective each other too frequently shares. How do we create a more cohesive team atmosphere that welcomes new ideas and respects each other’s needs and priorities? Together, we must step into the grey, be willing to be uncomfortable and find uncommon ground. Here’s what’s NOT working:

  1. Questioning every decision and challenging everyone

  2. Blaming people and pointing out their flaws

  3. Pushing WAAC – win at all costs – let’s show them how good we are!

What DOES work?

We currently have a client who must reduce operating room supply costs. They created a diverse team of surgeons, administrators and support staff from across the system to find opportunities to consolidate and reduce complexity and unnecessary redundancy. Physician pushback was anticipated, given strong personal preference and reluctance to change what isn’t broken from a patient outcome perspective. However, the team discovered the costs were unknown to most, if not all, surgeons. When presented with the cost differences for many items and how much this would eliminate the need for nurses to train on multiple, yet similar, items for individual surgeons, they too could not justify the need in many instances.

Not only will a collaborative culture inspire a group to find new ways to enhance patient care, but it also led clinicians and hospital administration to better identify avenues to cut costs and improve efficiency. Hospital administration is now empowered to make more strategic investments that benefit doctors and patients. What’s the financial win here? It dramatically frees up capital to invest in other more strategic endeavors, i.e., new operating rooms, surgical technologies, etc. Isn’t cutting costs  also in the patients’ best interest, as they want medical bills to be as low as possible, while not diminishing the quality of care?

All too often, we think we see efficiency in control and coordinated efforts. While efforts must be disciplined in the healthcare enviornment, an ineffective structure can cut off common sense and create more friction and less dynamic movement to do two things – reduce costs and enhance patient care.

All Change is Bad Change

The next shift to uncommon movement forward is to address the uncertainty of change. Change can be challenging — especially for organizations at the top of their field. One executive feeling overly confident in himself bellowed, ‘We are the premier provider of outpatient surgical care in the US.’ I absolutely agreed with him…followed by, ‘…well why am I here then?’ As his ego came down into check, he said, ‘we’re consistently inefficient and thousand dollar bills are flying out the window.’ Great, now we have a direction to go!

His hesitancy to change for fear of losing his premier provider status masked what was really going on. Far too often, this is the case – the problem isn’t the problem – it’s just a sympton. We don’t dole out prescriptions or set a case up for surgery because ‘it’s a revenue opportunity’. We dig deeper into finding what is causing this ‘inflamation’ and angst. Anytime there is a horizon of a new way of working or thinking, the feelings of unease and vulnerability, both from clinicians and hospital administration, begin to surface. Once we uncover how it manifests itself, then we have a direct path to potential resolution. Remember, the problem may not be the problem. Regardless, vulnerability can be beneficial. It keeps you hungry, learning and, most importantly, keeps you asking, ‘How can we better serve patients?’

Just as they welcome new cures or medical innovations, clinicians must apply the same appetite they have for embracing change in medicine to the systems side of the equation.

Another example is with our large academic medical center client who’s been looking to restructure its very profitable radiology department due to external competition from local independent imaging centers. While quality was unmatched, pricing pressure and convenience of location to the patient were becoming driving factors. By working together across their system, we were able to identify untapped capacity and economies through new ways of working collectively.

It’s no secret much of healthcare remains siloed with department chairs often having complete autonomy with minimal accountability. We challenged clinicians and hospital administrators to take a more holistic approach, consistently asking questions like, “Are we really at capacity, or are we not optimizing our efficiency?” Working in isolation and insulation is a certainty to stay stagnant and fall short of seizing opportunities to grow. At this system, nearly one in five surgeries involve multiple teams. We saved the best for last!

High Quality Always Equals High Cost

High quality care doesn’t have to translate into steeper costs and it doesn’t when it’s led properly. There’s a rhythm between ego, results and relationships. Our egos can prevent us from humbling ourselves to new, more relevant and clean data. Our relationships can become fractured when our egos get in the way or when we’re solely focuses on results at all costs. Our results can be less than favorable when our egos boast our pride and arrogance instead of a willingness to sacrifice and lead. Our results can also suffer when we become to focused on everyone’s self esteem by leading in a weak an ineffective realm. Cost and quality of care aren’t mutually exclusive and don’t need to be competing priorities.

There is a notable difference between per capita spend on healthcare, in relation to GDP, in the U.S., as compared to numerous other wealthy nations with world-class healthcare systems. There are also numerous examples of hospitals able to achieve better care outcomes at lower price points — even within the same region. We’re not going to step on the trillion dollar money-grab that is big pharma today, but you’ve have to be blind to not see how profitable it is to perpetuate sickness than it is to solve critical diseases…I digress.

Physicians may perceive hospital admins sole focus is on margins. However, possibly discharging patients to a step-down option to shorten the duration of hospital stay, for example a hotel, can reduce costs and increase bed capacity, while also reducing patients’ risk of infection, enhancing mobility and leading to potentially a better and quicker recovery.

Breaking down silos and identifying new ways to collaborate will help narrow or close gaps. There are countless areas of opportunity to seize and areas for significant improvement. It is our experience, a critical element is to strike a healthy rhtyhm – remember nothing ever balances – between the push to enhance quality and pull to cut costs. The silver needle we choose to deploy is to pull opportunities along that serve both ends.

While there’s no silver needle to navigating the complexities of a constantly evolving healthcare environment, one thing remains: several minds are better than a few. By breaking down deeply-held biases that obstruct effective collaboration, clinicians and hospital administrators will clear a pathway to more creative problem solving that eventually enhances patient care, cut costs and provides a clear competitive advantage needed to stay ahead. If you received value from this article, please pass it along as someone else may find value as well – we’d appreciate your share. If some of what you read is too familiar in your world, we welcome an opportunity to have you bounce ideas, thoughts or a contrary opinion anytime; no strings, no salesy crap. Click here to access my private calendar for a insightful conversation.

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