No Margin, No Mission & Other Hospital Myths We Need to Forget

During my dozen years as a hospital administrator, I often posed a question to managers and staff: we‘re all likely to be patients one day, so how do you want to be treated when your time comes? When I asked this of a roomful of people, I could always see them thinking about the answer. It was an effective way to remind the audience - from nurses on the floor to a group of new employees - about the patient care values of the organization.

?I worked in health systems where finance was the tail that wagged the dog - and I hated it. Sometimes it felt as if the hospital was an accounting firm that did health care. In these hospitals, the finance people set the goals, and the hands-on caregivers got in line behind revenue. When I got my chance at leadership, I swore that the standard would be patient care values to inspire staff. I was confident that if staff were inspired, patients and medical staff would be satisfied, and the money (margin) would take care of itself. When I was supported in this vision by the Board, the hospital was wildly successful.

?No margin, no mission should be restated as no inspired staff and no satisfied patients equal no margin. It supports the truth that we will indeed all be patients one day, and how do we want to be treated?

?Even Hospital CEOs Will be Patients

?I worked with a colleague who once quipped: "The best outcome is you come out." Modern medicine has achieved such a level of competence that unexpected deaths are shocking.

After a Chicago hospital CEO died following a heart valve procedure, her family filed suit claiming negligence. The family maintains that instead of attempting to repair the heart valve through a minimally invasive robotic procedure, the surgeon should have opted for a valve replacement. The CEO died after three weeks in the ICU after suffering a heart attack during the surgery. Her caregivers were unable to transfer her off a bypass machine. The family said that they were informed that the procedure had a 98% chance of a successful outcome.

Of course, there's always more to the story when a patient dies unexpectedly. Most likely, the insurance company for the University of Chicago Health System will opt to settle the case. For the insurance company, it will be a business decision to compare the cost of settlement to a trial and a jury decision.

?By all accounts, the CEO was dedicated to patient care. No doubt, she had the utmost confidence in the surgeon performing her procedure. I know I did whenever I had a procedure at the hospitals where I served. When I checked the website for Silver Cross Hospital, the Values are aligned with good outcomes. The first listed value is Safety – Do no harm. Her husband and son said the lawsuit was to prevent the same tragedy from happening to another family.

?If Nurses are Understaffed, They’ll Tell Patients and Families All About It

?A recent NPR story told of a retired detective who investigated his wife’s death at an Oregon hospital from pulmonary failure after staff constantly complained of being short-staffed. As the account noted:

?Today, Lillard believes he has an answer: overwhelmed, understaffed nurses hadn't been able to respond in time as Ann's condition deteriorated. He has made it his mission to fight for change, joining nurses' unions to push for mandatory ratios limiting the number of patients in a nurse's care. "I without a doubt believe 100 percent Ann would still be here today if they had staffing levels, mandatory staffing levels, especially in ICU," Lillard says.

?His determination was part of the widespread effort in Oregon to pass recent mandatory staffing regulations. This is despite hospital groups having lobbied and spent to kill such initiatives, citing a shortage of nurses. However, nursing unions disagree:

?…nursing unions say that's not the full story. There are now more actively registered nurses in the US (over 4.7 million) than ever before, with an estimated 130,000 new nurses entering the field between 2020 and 2022. The problem, they say, is a hospital industry that's been intentionally understaffing their units for years in order to cut costs and boost profits. This isn't, they say, a shortage of nurses. It's a shortage of nurses willing to work in those conditions.

?I’m reminded of a confused, elderly man at a hospital where I served who fell getting out of bed, hit his head, and died. He figured out how to circumvent the bed alarm pad he was lying on. And even though there was a Fall Risk magnet on door frame, these precautions did not prevent the patient from falling and dying. I met with the man's daughter, who had been at his bedside several days of his stay and had prevented him from getting out of bed several times by alerting nurses. I told her that his fall was unacceptable to me and the staff. I immediately authorized the purchase of six state-of-the-art beds with alarms built alarms for high-risk patients. The daughter was satisfied that we had addressed the problem and did not initiate legal action.

?But this incident is an example of a corollary that I have mentioned before: There's never enough budget to fix a risk problem in a hospital until something goes wrong, and then money can't be spent fast enough.

?Where is your next unexpected patient death likely to occur?

?A Bit of Good News

?Last April, I wrote a post about the financial woes of my local rural hospital. I’m happy to report that the leadership team appears to be turning the facility around. According to a recent article in the Grand Junction Daily Sentential:

?Delta Health anticipates an end to its five-year streak of multi-million-dollar operating losses by the end of 2024.

?Well done to the leadership team and Board at the hospital. In a time when rural hospitals are closing rapidly, this is no small accomplishment. – John W Mitchell, MS blogs at https://healthcarecsuite.com/