Someone recently asked me, "Why do hospitals fail?"
While this question is nearly impossible to answer in general terms, the dear Tip O'Neill [former Speaker of the House from 1977-1987] was mostly correct when he stated, "All politics is local." The same goes for healthcare.
One could argue a key element of success, no matter where you are located, is to remain highly relevant in your market. As a hospital slides into a downward path of irrelevancy, they tip toward failure.
Here are 11 things hospital leaders do that lead to irrelevance — and ultimately failure.
1. Treat physicians like commodities. Yes, I know everyone is important. Those aren't just words. An organization is a fine fabric. Start pulling threads and not only is the integrity compromised, but it doesn't look very good either.
Why do we sometimes act as if physicians are not the key element? They are, deal with it. Listen to them and give them a seat at the board. Do something crazy, like ask the medical staff to vote on a board representative. CEOs, quit treating physicians like a replaceable cog in the wheel (don't pretend you don't know what I'm talking about).
2. Leave your destiny to others. So you've gotten along pretty well with physicians and decided no, you don't need to recruit. Bzzz. That means you didn't understand the ramifications of provider-based billing and probably shouldn't have your job right now.
I use past tense, because for some, you're too late for provider-based billing. A hospital must make certain they have a medical staff adequately equipped to meet the needs, demographics and desires of your market. Every primary care physician is worth roughly $1 million in perfectly proper referrals. Let that fact sink in. Failure to keep a medical staff able to capture the market prone to use your services is the surest path to irrelevancy.
So go ahead, leave the hiring to someone else. After all, your medical staff is good to you today.
3. Don't demand competent budgeting from your accounting department or listen to their projections. One of the most powerful tools in any C-suite's hands is a four-year budget. Done properly, you have time to plan and time to adjust. Ignore the process or give it the same amount of time as you do when considering a new MRI, and you'll pay the consequences.
Many of you are one government "add-on" program away from a negative margin. Really now, do you know what you would do if one of those programs disappeared, or would it take you years to adjust while you're bleeding margin?
4. Allow a board to dive into details, spend your time answering their operational questions or worse yet, implementing their detailed, operational desires. Leaders lead, and there is no better time to demonstrate that than to guide your board into proper broad and community-focused goals and objectives. Then, you must accept accountability of the goals they create. The C-suite gets paid what it's paid for a reason. No one said all the conversations would be comfortable.
5. Ignore 'cash is king' and assume your revenue cycle and EHR vendor know what's best for you. Having done many of these implementations, I know for a fact an over-reliance on a vendor is a sure path toward staff alienation, a ruination of cash flow and a very damaging perception in your market. Your organization must have people on staff your vendor would covet as employees to implement their systems. If you can't say that, oops.
6. Ignore your patients. After all, talk about what millennials want is just a fad. And the rest of our patients are used to how we do things. Sure, fail to invest in apps. After all, who uses smartphones these days? Make statements hard to understand, ignore easier scheduling processes, let patients wait forever on the phone, put people through agonizing processes to get an MRI and let them wander your halls without knowing where they're going. Thinly disguised contempt for patients is yet another path to irrelevancy.
7. Fail to hire wisely and once hired, find any excuse to keep them no matter what their performance. I contend leaving a legacy is a rare thing. Those who think they depart with one are mostly basking in their own image. As my dear grandmother said, "The cemetery is filled with indispensable people." What legacy we may leave exists with those we hire. That's it. So go ahead, tolerate a low-functioning team, and do nothing about average managers. I'm sure it will "just get better" a year or two from now.
8. Ignore details, and see how it turns out for you and your organization. If you bask in enlightenment over item seven, you can get away with leaving most details to others. But someone has to do it. Should you become a slave to details? Of course not. But if your day is consumed in mostly worthless meetings, (admit it) you are missing out on seeing management from the eyes of patients.
Get up and walk around a lot; you'll find things that cause patients to draw conclusions about your hospital, both good and bad. Taking the time to find such things and heap praise or demand improvement makes a statement of its own. Once you create a culture of "the little things matter," it becomes easier for you to back away from it a bit as others take up the cause.
9. Make the need for empathy irrelevant with your silence on the subject. After all, empathy is highly overrated. We're providing good care with good results and that alone will win us market share. How's that working for you?
Every conversation, every interaction should begin with a mental acknowledgment for the need to show empathy. We're in the hospital business for goodness sake, how did this become lost on us? It doesn't matter what your job is or who you are dealing with. If you begin with empathy, interactions change for the better and patients' impressions of us change with it.
10. Ignore what's happening around you and merely concentrate on what occurs within your walls. Consolidation may or may not be in the cards for you, but why do we allow it to be forced upon us after a prolonged mental status of denial? "My board doesn't want it." What an easy out. Don't share your thoughts with legislators. After all, those emails take too much time and I'm just one voice. Don't challenge your leadership team with thought-provoking, market-disrupting scenarios. Yes, act as if you're the only hospital your market will ever want to use.
11. Lack the courage to lead. You can all think of an issue your organization is facing right now, yet you hesitate. It's fraught with political peril, it involves too much of your time, and it requires going against the institutional "we've always done or thought this way" mentality.
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