In this special Speaker Series, Becker's Healthcare caught up with Leslie Marsh, CEO of Lexington (Neb.) Regional Health Center.
Ms. Marsh will speak on a panel at Becker's Hospital Review 7th Annual CEO + CFO Roundtable titled, "Community Hospitals — Regional Strategies and Affiliation Considerations," at 10:10 a.m. on Wednesday, Nov. 14. Learn more about the event and register to attend in Chicago.
Question: What keeps you excited and motivated to come to work each day?
Leslie Marsh: Connecting to purpose is almost effortless in healthcare. Being able to impact someone's life is a compelling incentive. While I may not be the person directly responsible for "saving a life" or helping someone manage their disease more effectively, I do get to work with the compassionate, dedicated people who come to work every day intent on making a difference. Seeing that commitment and selflessness is motivating and humbling.
Q: How can hospital executives and physicians ensure they're aligned around the same strategic goals?
LM: In the current healthcare environment, the notion that hospitals and physicians have the same strategic goals is only true in the most general sense — both hospitals and physicians care about the patient's overall care and mortality. But, at the operational level, their goals are widely divergent and often contradictory. The hospital executive is trying to keep the doors of the facility open, meet hospital-specific quality metrics and comply with regulations, while the physician is responding to a completely different set of institutional objectives and responsibilities. Is there any hospital executive who doesn't understand that margin and mission are inextricably linked? To move the strategic goals closer requires new reimbursement models with a shared set of incentives designed to bring the two groups into closer strategic alignment.
Q: What's one conviction in healthcare that needs to be challenged?
LM: The current cost-containment environment has sparked a sharp focus on providing the appropriate care at the lowest short-term cost. But, as computer simulation modeling pioneer Jay Forrester pointed out in his famous journal article, published in the Technology Review in January 1971, a focus on the short term often leads to poor long-run results. In Forrester's own words:
The short run is more visible and more compelling. It speaks loudly for immediate attention. But a series of actions all aimed at short-run improvement can eventually burden a system with long-run depressants so severe that even heroic short-run measures no longer suffice.
For example, if we discharge a patient from the hospital as quickly as possible it will decrease the immediate short-term costs (reduction in payment for length of stay) but may lead to increased costs over the long run. There have been a number of studies, one cited by CMS, that indicate that spending less money upfront can cost more in the long run. Readmissions to hospitals with longer stays due to complications, earlier lifetime admissions to nursing homes, and an overall decrease in functional capacity have all been noted as being correlated to early dismissal from hospital or a reduction in front-end hospital health care spend.
Defining long term goals correctly is difficult when dealing with complex systems; however, it will be critically important to do just that in order to transform healthcare delivery in a meaningful way.