03 September 2013
Hospitals – Money Is the Only Driver
Hospital leaders are either enlightened or not. If you look hard enough, you can find many enlightened leaders that have embraced hospital capacity management. These leaders view the emergency department (ED) as the front door to the hospital. These leaders understand that the ED interacts with more patients, family, friends, and providers than any other area of the hospital. This means that the ED is an enormous generator of capacity management, not just affecting the ED, but the entire hospital. Therefore these leaders move resources, implement new processes, such as well-run and staffed observation units, to address the management of the capacity issues directly affecting patients waiting for a hospital bed.
Dr. Robbin Dick is a little over the top, but he has a right in many cases and does spell out some of the shortcomings found in many hospitals. It has a lot to do with who has what position in the hospital pecking order. Some hospitals only operate this way and the higher up the ladder a particular doctor, the more control he/she wields and some wield this control for every advantage to them. Others care and share duties and see that procedures are within the needs of the hospital.
Often it is the surgeons and cardiologists that are high on the hospital ladder and they demand that their needs and lifestyle are fostered at the expense of everyone else.
I was surprised by Dr. Dick's statement in his blog, but in discussing this with now three different hospital administrators, he is right with one exception. The exception hospital is run by Nuns to this day, and they do not hesitate to fire any doctor that thinks he/she has a lock on the hospital ladder and start demanding certain things happen for their benefit. When I talked to the head of the hospital recently, she apologized for not responding to me earlier, but employee matters were taking more time than they should. I know this person and asked her point blank if she was referring to the two surgeons no longer on the hospital staff. She laughed and told me I had been reading the local paper, which was true. Many hospitals have retained religious ownership, but are run by other people trained for this. This is a rare hospital.
This hospital will admit that the ED is the driving force and they do make way for the patients arriving this way, but at the same time, she admitted that they space out surgeries when possible to make room for those arriving through the ED. She also stated that when surgeons feel that they have special hours, that is when their wheels fall off and out the door they go. In the last ten years she did say that have had 10 different surgeons. She maintains that they are all told that they have no special privileges and when they feel they do, to pack up and leave. They have four surgeons all working different hours on a rotating basis. Plus, she said they have eliminated four other surgeons and cooperate with another hospital in transferring specific patients to them.
This administrator admits that it would be great if they could be providing patient centered care, but this does not pay the bills. She does say that maybe this will happen in the future, but the current healthcare law will not permit this although some are claiming it is possible. She says if they do this, they will lose money unless they can divide the hospital and have a high profit side and a very low loss side.
The other point she made to me was something Dr. Dick rails against. She said that when doctors become too big for their britches, this means that the hospital will lose money. She admits that doctor centered care was a money loser and this she would not permit.