HealthCare Governance: The Band Plays On

Next in this Governance Series

Knowledgeable advisors, such as David Dibble[1] and others, offer pathways beyond the “innovation fantasy” that has mutated from “the business world” and infected American WealthCare with the sepsis of illusion. These prophets call for seismic shifts to system-thinking, and acting with transparency… with “what’s best for the patient and clinician” in mind. Course corrections amidst worsening turbulence.

Business gurus long have preached on the dangers of trying to improve customer satisfaction with artificial marketing and fuzzy gimmicks (see below).

Take care of your people, and they’ll take care of your business. Why would patient safety and satisfaction be any different?

Take care of your clinicians, and they’ll take care of your patients. And, may one add, your revenue cycle.

For many hospitals, it’s too late. These have closed, sold, merged, or are circling the drain. Enlighted administrators, physicians, nurses, and other clinicians are (to borrow the Chinese proverb/cliché) on a journey of a thousand miles. Most are not on their "first step," but the maps are outdated, and the GPS has gone haywire. Some insightful sherpas (many with clinical licenses) offer better cartography for the journey. But they have to fight hard and long to be heard, much less heeded.

Imagine! Starting Problem Solving "with the voices of the entire care team being heard"!!!

We've awakened to a shocking Bizarro World of WealthCare where "management" pays consultants to teach how to pay attention to clinicians who actually touch patients. And these are the "administrators" who are paid mid six and up to serious seven figures. Many are hired under the canard: "Recruit for Attitude, Train for Competence." Yes, this is elegantly painted on the wall of a hospital system HR conference room near you.

Two years ago, an “executive VP” (there may be a dozen or so scampering about your hospital group, checking their smartwatches for the next Teams meeting) sought counsel from one who had advised his system for decades. The consultant posed some questions and observations about visible, publicly-known dysfunctions in the organization. The executive’s remarkable response to these consultative (and admittedly proctoscopic) inquiries about the devolving state of the employer that pays him hundreds of thousands in pay and benefits? “Well, Lou. My house is paid for.” To his credit, he drives a Honda, in contrast with the $80-100k rolling stock preferred by his colleagues. In this exchange, we see good personal economics, but where is the competent exercise of fiduciary duty?

News sources like Becker's report the daily carnage in WealthCare economics. The layoffs at leading systems (https://tinyurl.com/2t4zjhxx ) and strikes from Stanford to Minnesota (https://tinyurl.com/ybf3bjzf ). C-suites racing to their exit packages (https://www.dhirubhai.net/pulse/see-how-run-ted-l-ramirez/ ). Other sources tell of broken lives, the suicides. The abused clinicians ISO another career, “Uh, maybe real estate.”

And guess what? None of this is Trump’s fault. Nor Biden’s. Nor any other politician you love to hate. We have done this to ourselves.

Yet, the doomed party grinds on, like Belshazzar’s Feast.[2] Without the dancing pagan girls, since the band is stuck on Nearer My God to Thee. https://www.youtube.com/watch?v=_RcVzevWX4U Or like the banker from yesteryear who kept lending to his pleading, insolvent Optimist Club buddy, “Please, Jake! Just another fifty grand! I know we can turn this around!” Bricks and mortar, expansion plans with hidden pro formas and doomed projections.

Some of the real “legacy builders” in WealthCare have launched one of Hail Mary's of business: Long term multimillion dollar sports deals where the franchise’s lawyers stick it to the “lambs in wolves clothing” from the hospital C-suite, in some woe begotten brand sharing. The rank-and-file and most clinicians gag every time they see that team logo. The consumers chuckle and the local business people just laugh.

Then there are those diligent marketing peeps ordered by the C-suite to generate “branding strategies” and logos on plastic junk trinkets stored in closets until they can be pawned off at some charity give away, or in goody bags for the board next time they convene. Plus those glossy publications that stress all the “innovation” going on, the ground-breakings, and ribbon-cuttings. Terabytes of pictures, videos, and unsolicited postal mailers that will make great fire starters in a few weeks.

Oscars nominations also go to sleeping, “trust-the-GIC’s”[3] boards and greedy C-Suites (ok, perhaps well-intended, but lost – some even admit it), jammed with cronies and inattentive, inexperienced persons being “trained for competence.” Massive, doomed OJT operations. "On the Job Training"… because they know somebody who got them the job and who now protects them. And, perhaps the saddest cohort, ex officio religious and community leaders whose visible functions are to pray at board meetings for blessings and that trouble will all go away somehow. They also preside over all those ribbon cuttings, gold shovel ground breakings, lunches, and dinners. All hypnotized by fancy “retreats,” galas, rivers of benies doled out by the GIC's. Secret pay-offs, AMEX cards, and unaudited T&E reimbursement reports. Steak dinners, sauvignon, first class flights to Europe, five-star resorts. Annual phony-baloney "continuing education conferences" in Hawaii. Here, they are "educated" on subjects including fresh sea bass, ahi, and crème br?lée?dinners, of helicopter rides, ocean fishing, and golf on PGA courses.

This is not Goldman Sachs, Blackstone, or Exxon-Mobile, folks. There are doctors, nurses, and sick patients waiting for us all to put out the fire, to grow up and pay attention.

Yours for Better Governance,

Ted L. Ramirez ?2022

[1] https://www.dhirubhai.net/in/davidbdibble/recent-activity/documents/

[2] https://en.wikipedia.org/wiki/Belshazzar's???feast

[3] Guys - and Gals - In Charge. The evolving train wreck is gender neutral. Everybody plays.