Regina McNamara RN, MSN, MPH
Regina is president of Keisco Consulting Group LLC located in Cheshire, CT. She has provided interim management as well as consulting for several home care and hospice agencies. Her expertise helped these agencies manage challenges related to management, market, and reimbursement changes. She has helped to implement growth strategies, mentor managers and executives, and achieve new levels of profitability and productivity, achieving new levels of success for her clients.

 

These are tough times in healthcare.  Hospitals are competing for physicians and for paying patients, facing increasing regulatory scrutiny, and managing the ever-increasing demands of consumers.  The outpatient sector of the healthcare industry now pits physician groups against the hospitals they staff as both entities strive to succeed in this market.  In 2008, home care and hospice agencies will have to contend with new and more burdensome regulations that threaten to increase resource consumption and decrease profits.  Add to this mix serious staff shortages at many levels and mounting numbers of uninsured patients, and a grim picture emerges. 

What’s happening?  Organization leaders are losing their focus and losing the battle for financial viability.  In the Northeast alone, there are a handful of healthcare organizations that are currently facing forced closure because they have failed to balance fiscal responsibility with delivering quality care.  Where exactly, have these organizations lost focus?  The core of their business: the patient. 

Below is a list of mistakes struggling organizations often make.  To their peril. 

1. They continue with the illusion that high quality is an unachievable and expensive goal 

An abandonment of a commitment to quality that starts at the top of the organization invariably results in a depletion of vital resources at all levels, and has immediate and profound effect on the organization’s bottom line.  Medical errors, nosocomial infections and poor patient outcomes all result from this shortsighted approach.  There is nothing more expensive than poor quality care.

2. They neglect their customers

Common mistakes include:

• Distributing patient satisfaction surveys and doing nothing to address the concerns of patients. 
• Calling patients during outpatient or home care services, but not listening to their concerns. 
• Neglecting the small things that matter most to patients, such as courtesy, clean rooms, responding to calls and genuine caring.

3. They abdicate responsibility for care quality – they delegate it to the patient and family instead

Though it is important, and sometimes required by regulatory bodies, to keep patients and their relatives well-informed as to all aspects of their care, this does NOT mean that a patient or relative should ever be burdened with enforcing compliance with basic quality and safety measures.  For example, to request that patients ASK their nurse or physician to wash their hands before caring for them or that they MEMORIZE their own medication schedule to make sure they remind the nurses to administer the right med at the right time is to abdicate responsibility.  This approach is unfair to patients and unpopular with regulators.

4. They do not follow through on identified quality and safety concerns

While identifying quality and safety concerns is simple, drilling down to understand root causes, core processes and systems that need to be changed, and then implementing those changes is difficult.  This requires not only daily vigilance and perseverance, but a commitment of resources.  That said, when an organization neglects quality and safety concerns, falls, errors, and infections increase.  Quality erodes, and the future of the organization is at risk.

5. They focus on creative and expensive recruitment schemes and NEGLECT RETENTION

Deploying considerable resources to recruit new hires will result in short-term fixes.  Enlightened organizations focus on retention.  Neglecting your existing, well-functioning employees is a sure fire route to eroding profitability and quality.

6. They use unions as an excuse to avoid accountability

Your staff being union-organized is not a reason to abdicate leadership or to not hold all staff accountable for high quality work.  Salaries and benefits are negotiable.  Quality of work is not.

7. They treat physicians as the only customer

Particularly in multi-hospital cities, there is a constant “war” to attract the best physicians.  Escalating salary and compensation packages, as well as other assorted perks, are designed to lure these practitioners.  One hospital “won” the loyalty of a large group of OB/GYN physicians by agreeing to assume the cost of the group’s annual malpractice premium.  Cost?  $5 million annually.  How to fund? $5 million in layoffs of direct caregivers.

8. They make excuses to patients and/or are defensive

Leaders rarely, if ever, address patient concerns directly; they send patient representatives to make excuses and speak defensively for them instead.  This is a mistake for two reasons:  a.) it allows leaders to remain out of touch, and b.) it rests the reputation of the organization on the shoulders of mid-level, and possibly disgruntled, employees.  In organizations in which quality is lagging, representatives invariably spend time excusing and defending how hard the staff works and how resources are limited.  Worse, they blame patients for neglecting their “responsibilities” with regard to their care.

9. Allow bureaucracy to slow down progress

Often the very best ideas originate in the middle and lower levels of the organization.  This stands to reason, as middle and lower-level employees are closest to the product - patient care.  Leaders cannot allow that good ideas for proposed changes become bogged down by committees or complicated by egos and turf wars.  This delays change, sometimes indefinitely; this is a sure, and common, road to failure.

Failing or failed organizations whose quality and profitability have deteriorated have strayed from their core business and their primary customers – their patients.  Successful organizations never neglect their patients.  They never lose focus of the basics of their business:  quality product, satisfied customers.  One very successful Southern US hospital has its motto, “Every Patient is the Only Patient,” engraved in the front of the hospital.

Focus on the patient and succeed.  Neglect the patient and suffer the consequences.

It is a simple matter to retrospectively analyze the common components and practices of failing healthcare organizations.  It is far more complicated to look within your own organization and ensure that, every day, leaders carefully and critically assess their systems, practices, and outcomes, and that they listen to their customers.  In failing organizations, the signs are apparent.  Watch for these before it is too late for yours.

Regina McNamara RN MSN MPH
President
Kelsco Consulting Group LLC
1035 So Main St
Cheshire CT 06410
203 910 5157
Fax 203 879 2099
Email: rfmcnamara@aol.com

Regina is president of Kelsco Consulting Group LLC. In Cheshire CT  Her firm specializes in helping health care organizations throughout the country improve profitability, productivity and quality.

 

____________________________________________________________________________________