Since I began researching and reporting on the healthcare industry, some 25 years ago, hospitals have always been my favorite sector to explore. Whenever I say this, both my professional colleagues and personal friends look at me oddly. So I’ll explain.
A grand introduction
During the first few years of my career, I did the grand hospital tour of my part of Florida. I visited with about 50 senior executives in South Florida hospitals, or more or less every institution within a 100-mile radius. At the time, most were independently owned and operated, though now-Florida Governor Rick Scott was just beginning the hospital acquisitions which would form the core of Columbia Hospital Corp. I was getting pure, unadulterated Hospital Management 101.
For a wet-behind-the-ears junior reporter in her early 20s, it was very flattering to speak on more or less equal terms with CEOs who were bosses of hundreds or even thousands of people and commanded multi-million dollar budgets.
But what really got me excited about meeting them was seeing the CEOs “pull back the curtain” and explain — to some degree at least — how the astonishing number of moving parts actually functioned. It was like watching a technical genius pull the cover off a supercomputer and tell me exactly what those flashing lights, wires and chips could do.
The more I learned about hospitals, the more I was awed by the astonishing ballet bringing personalities, training, technologies, infrastructure and finance coming together into patient-by-patient care. And I was determined to master core hospital industry knowledge well enough to tell stories right, analyze trends properly and collect the right data.
Why hospitals are magical
Since those days early in my career, I’ve become convinced that hospitals are among the most magical institutions in the entire healthcare spectrum. While I’m sure hospital leaders can’t take time to dwell on this, it’s just astonishing that they manage to help as many patients as they do. The number of gears that have to mesh to say, get a moderately sick ED patient diagnosed, treated and admitted is beyond what virtually any other industry must engage.
Now, don’t get me wrong, I’m completely aware that bad hospitals with poorly meshing gears, indifferent staff or broken processes kill people every day. Some get closed down by CMS. (Here’s a particularly egregious example of a deadly facility, Los Angeles’ Martin Luther King Jr./Drew hospital, closed in 2007 after failing patients on just about every level.) And it’s no surprise to me that hospital staffers and clinicians make medication errors and surgical never events happen. But what continues to surprise is how rare they are statistically.
Maybe I’m romanticizing their mission too much — they are businesses of course, some of which with, for example, charity care policies that appall me — but I see well-run hospitals as the key to transforming the health of the nation. I’m not trying to minimize the critical work that community doctors, home health organizations, nursing facilities and other critical health organizations do, but I am suggesting that we rethink their relationship to hospitals.
Build from the center out
To me, the best way to harness hospitals’ amazing strengths is to centralize them as controllers of care, integrated far more intimately with their partners in other sectors. Obviously, this has been going on at a rapid clip with physician practices, but I’d like to see more community health planning work from the center out.
I’m certainly not suggesting that most care should take place in the hospital physically — you’ll never meet a bigger fan of mHealth/connected health/remote monitoring than me — but that hospitals are the only ones with the administrative and data management capacity to manage the health of a population. (We certainly don’t want commercial payers controlling everything, which is pretty much what we’ve got today.)
Ultimately, though, I have to admit to a sentimental attachment to hospitals, which opened their doors to me and led me into the endlessly fascinating world of healthcare.
And when I walk through the doors of a well-built, welcoming, well-staffed hospital replete with everything it takes to meet my health needs, I feel absolutely safe. And that’s how it should be, no?