Michael Brant-Zawadzki, MD, FACR, serves as Senior Physician Executive, The Ron and Sandi Simon Endowed Chair of Hoag Neurosciences Institute.
On April 3rd, Dr. Brant-Zawadzki will speak at Becker's Hospital Review 10th Annual Meeting. As part of an ongoing series, Becker's is talking to healthcare leaders who plan to speak at the conference, which will take place April 1-4, 2019 in Chicago.
To learn more about the conference and Dr. Brant-Zawadzki's session, click here.
Question: What do innovators/entrepreneurs from outside healthcare need to better understand about hospital and health system leaders?
Michael Brant-Zawadzki: Health Care System and Hospital Leaders have each leg in a separate canoe, as they try to navigate the direction of their industry river’s currents. Although the Health Industry is becoming increasingly consumer driven, unlike in many other industries the consumer is not the sole payer for services rendered. The degree to which the consumer pays is directed by disparate intermediaries, including increasingly the government, thus there are multiple customers, each with distinct expectations and contractual arrangements. Margins vary considerably based on the particular customer, yet all share similar expectations of clinical excellence and timeliness, service excellence and patient satisfaction, as well as value: better health per dollar spent.
All this, in the context of scarcity is a challenging place to lead. Scarcity is the first law of economics, as stated by Thomas Sowell, a noted Stanford economics scholar: “There is never enough of anything to satisfy all those who want it”. Targeting the costs of operations to the lowest common denominator, eg Medicare, may risk providing levels of care that would attract customers with better margin opportunities. Staffing hospitals aiming at peaks of demand to provide service excellence risks margins given the fluctuations of demand that are difficult to predict. Supplier cost pressures are constant, particularly with Physicians and extenders. A predicted shortage of approximately 100,000 physicians in the US by 2025 adds additional pressure to constantly innovate in novel access points, care efficiency, management of capital and other operational costs, especially with the growth of demand from a consumer base that increasingly perceives the services as a “right”, even one that should be paid for by others.
Unfortunately, as Margaret Thacher once observed, we run out of other people’s money. Health leaders must thus deal with increasing scarcity as the politicians continue to promote the first law of politics, that is to ignore the first law of economics.
Q: What one strategic initiative will demand the most of your time and energy in 2019?
MBZ: Growing facilities, specialized programs, and innovating delivery systems is my passion, but the one thing that now consumes a disproportionate amount of my attention is the mental health impact on our physical health services. This includes the entire spectrum of teen and adolescents, young adults, moms with peri-partum mood disorders, and seniors with cognitive and memory issues: Depression and substance abuse - “self-medication” - resides across all those.
The traditional ROI on creating or improving health services focusing on mental health issues is dismal. Yet the tremendous hidden costs to the health care system that accrue from underlying mental health disorders can no longer be ignored, not to mention the human misery they entail.
As an example, 23% of our ED bed capacity is taken up by those presenting with primary mental health crises (limiting ED access), and over 30% of our med-surg in-patients have mental health co-morbidities, which prolong length of stay, are an emotional and sometimes physical challenge to our staff (which adds to HR costs). One can evade reality, but one cannot evade the consequences of evading reality.
Q: Can you share some praise with us about people you work with? What does greatness look like to you when it comes to your team?
MBZ: I am fortunate to work in an organization that started as a Hoag family effort, and that family atmosphere is in our DNA. With our origins in the community, and with continued astonishing philanthropic support, our accountability to our community partners is deeply felt throughout the organization. Everyone, from the environmental staff to the CEO, “owns it”. We aim for a flat authority gradient, and constantly improving our work as it is being done. We all spend more waking time at work than at our own homes, and the pride felt by every staff member reflects the commitment to the community, our patients, and each other that our family roots reflect. Our many accolades are merely a derivative of Hoag Pride, and not the other way around.