CHICAGO — Everything goes in spits and spurts.
That wisdom was from my Grandmother Jackson. Note the capitalization of the “G” in grandmother. Ms. Cora was worthy of that respect. She created and she sustained so many wonderful memories of my youth and, day in and day out, her values helped create a foundation for the person I am today.
Ms. Cora was a wonderful woman who successfully and gracefully raised seven children through the darkest hours of the Great Depression and a World War. She knew what she believed and she stuck with it. She was a wise observer of the inequalities and inconsistencies of everyday life.
Today, I have come to believe that her spits and spurts comment reflects the history of the healthcare industry. We run off this way, or that way, in pursuit of the latest fad. Then, when Modern Healthcare reports how misguided this or that strategy is, we announce, with great fanfare, our intent to focus, once again, on our “core” business and values.
Lets begin with the fads. A respected healthcare thought leader and journalist who I admired so much, the late Sandy Lutz, once said that the best way to describe the numerous “latest and best new strategies” in healthcare was to say that “the list is long and distinguished.” We buy hospitals in hopes of creating a patient referral network and then, when we struggle to make them profitable, divest our investment, usually at a loss, because we believe that owning a network of hospitals is not part of our central mission. Then we buy physician practices, intent on creating a seamless continuum of quality of care (control physician referrals) only to come to understand, after losing a bloody fortune for each doctor every year, that this, too, was not central to our core enterprise.
The truth is, we seem to be an industry that would rather react than lead.
The same can be said for our ethics.
OK, before you click the delete button because you might read something that offends you, hear me out.
As a recruiter who interviews a good many physician executives, I am hearing, with increasing frequency and despair, stories from across the country of medical schools, health systems, hospitals and nursing homes that are going out of their way to cover up significant issues with quality of care and patient safety.
This anecdotal trend suggests that some hospitals, in a panic to meet their budgeted numbers in an era of declining inpatient admissions, seem more intent on protecting, or encouraging, big admitters who may be performing procedures they shouldn’t, rather than the patients who they are harming.
This noticeable increase in horror stories suggests that the “butts in the bed” mentality of business development is winning out over the ethical admonition of First Do No Harm.
Now the sad part: At far too many community and university teaching hospitals, doctors who report these inappropriate activities, or inexpert clinical practices that harm patients, are being treated as enemies of the state. They are being drummed out of the corps.
When we – hospital board members, executives, nurses and other physicians – turn our heads and assume the “go along, get along” position, allowing sloppy, careless or blatantly unethical practitioners to get away with bad or dangerous behavior, we are compromising the integrity of the whole of the healthcare industry.
At a time when the public is increasingly concerned about costs and quality, the trend of one or two doctors, whose bad behavior or sloppy technique is allowed to slide for political expediency or financial gain, will gradually morph, in the public’s eye, to a blanket level of suspicion regarding the integrity and intent of all hospitals and all doctors.
This is a real and growing problem. In five to seven years, as the transformation of healthcare creates disruption and public unrest, this loss of confidence could be irreversible.
And just think, it began with spits and spurts.
© 2019 John Gregory Self