Key thoughts:
• “Mission drift” describes a shift from a defined mission to meet other demands
• There are many examples of this in healthcare, often based on financial and social stressors
• Mission drift results in loss of identity, integrity and ultimately weakens the institution
• Recognizing early signs of mission drift will help avoid these pitfalls
Healthcare today is typified by change more than ever before, from the technologies used in its delivery, to institutional consolidation and the quest for economies of scale. Through these transitions there are many factors that pressure hospitals and health systems to make tactical decisions that may not support patient care, or even just to survive in the marketplace. But over time, this behavior is at risk of sustaining itself and distracting from the core mission.
The term “mission drift” was used by Pim Engels in 2010 to describe an identity crisis in microfinance institutions1, and has since been used as the title of a play, as well as a crisis in faith-based organizations.
There are many examples of mission drift in today’s healthcare landscape. As tertiary medical centers branch into the community, there is a natural shift to compete for primary care rather than providing for the sickest patients. The emphasis on clinical revenues is driving academic medical centers to encourage their faculty to see more patients rather than performing ground-breaking research. The financial stressors of high overhead and low reimbursements may lead a charge to focus on financial stability over promoting the quality of care. And stating you want to be the “best” without committing the necessary resources leads to a failed vision.
Mission drift ultimately degrades the integrity of the institution, and leads to an un-cohesive workforce and mistrust among physicians.
Recognizing the roots of mission drift is important in order to avoid its pitfalls. It can occur as a result of leadership responding to short term financial or regulatory demands, or it can occur as a result of the collective mood of the workforce if they are not individually supporting the mission. Clues that you’re at risk for mission drift are 1) being reactive instead of proactive, 2) your vision is under-resourced and not achievable, and 3) financial performance is the prominent line of discussion in the boardroom.
We all have patient care in our mission, and physicians and nurses are central to this quest. Keeping leadership on target improves alignment and hopefully achieves our common goal.
1 P. Engels, Mission Drift in Microfinance, ibidem-Verlag, 2010.
This column is part of a series devoted to clarifying and enhancing the physician-health system relationship. Dr. Ken Altman is Chief of Otolaryngology at Baylor St. Luke’s Medical Center in Houston, TX. He is also Secretary/Treasurer-Elect of the American Academy of Otolaryngology – HNS, and past-President of the American Laryngological Association.