Tuesday, March 28, 2006

Summers, Harvard, and Hospital Administration

Applying the Summers and Harvard story to hospitals, regular contributor Neil Whipkey offers the below words of wisdom.

I find these words interesting not only for what they say about the direct subject at hand, but also for what they say about the nature of the health care business and its problems. In what other form of enterprise would it be necessary for a senior corporate executive to secure “a goodly number of champions” before beginning “to champion quality?”

Having been in the business for some years I [Whipkey] surmise that it is not infrequent for a CEO/Administrator to get out of town ahead of the posse, and sometimes not. It is an interesting process and can be quite an education for the CEO. To me the question of how the CEO navigates this minefield is not without answers. Granted it can be difficult but here are a few pointers, from my personal school of hard knocks:

* Issues need to be patient based (it is possible to make a financial issue; in fact, almost any issue, a patient care issue).

* Acquire some physician champions for your causes (take baby steps at first and remember the higher up the chain of influence your physician champion is the better your chances for success).

* When secure with a goodly number of champions, then begin to champion quality patient care/outcomes at the various committees.

* Present them with objective quality data on a regular basis. At this point do not go looking for any individual targets, just let the issues bubble up to the surface.

* When appropriate issues arise that demand immediate action (i.e., summary suspension), be prepared to take the necessary steps. WARNING: have a process in place that involves the Chief of Staff, Chairman of the Credentials Committee, and, if you wish, the appropriate Chief of Medicine or Surgery. Failure to do so will be the catalyst that gets the posse organized.

* Prior to initiating the process for a summary suspension, do your homework and have all of the facts laid out to present to the above referenced group. Enlist their support and try your best to get consensus for the action you are to take. Make it clear that this is an action you are authorized to take on your own. If you have done your homework and done it well you may be surprised at the support you get.

* Remember to keep it focused on patient care. All physicians wish to have it known that the facility they practice at cares about quality and deals with quality issues in a forthright manner.

* Keep your appropriate board members updated on what is taking place.

* Act and act decisively.

In almost 25 years in this business I have utilized the summary suspension twice. Neither time was easy but with the understanding and consent of the medical staff leadership I was able to avoid the posse doing their work. If we as administrators take patient care and quality outcomes seriously then we must be prepared to take some risk. Minimize those risks by building strong and positive relationships with your key players.

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