From Competitors to Partners

Just whose responsibility is it anyway to fix the medical system in the US?  Is it the AMA? The AHA?  How about hospital administrators in the aggregate?  What about policymakers; that is, when their work isn't being ignored or used as the reason for not supporting a purportedly necessary change (e.g., the Affordable Care Act).

This comes to mind because a hospital client has a terrible problem in the ER; like at 175% capacity and the other charity hospitals in this urban setting have even higher ER capacity rates.  The thing is, this is an incredibly cosmopolitan city with lots to do.  There's nothing appealing about hanging out in the ER; that is, if you can even get inside.  So that's certainly not reason for the big crowds.  If you ask the Chief of ER what the solution to the chronic overcrowding is, he'd tell you that there is some kind of discharge problem "upstairs."  He thinks that a whole bunch of inpatients tieing up beds should be moved into rehabilitation hospitals and other type settings post haste so they can cut the queue of gurneys lined up in the corridors and free up some badly needed ER space.

But if you look more closely at the situation, it goes beyond poor discharge practices.  This is not to say that every hospital couldn't stand to improve its discharge practices, which we would split into two primary areas -- behind the scenes coordination of services and communication to providers/patients.  It really gets into the system of health care delivery in a geographic area, and to what extent there is a reasonable balance between supply and demand across both acute and specialized care requirements.

It's quite possible that the capacity situation in a given geographic area is so bad that any possible domestic (i.e., within a given hospital) improvements to discharge planning and other patient flow solutions are put to the side because of a collective "what's the use?"  Or more in the spirit of the AA prayer, 'lord grant me the wisdom to change the things I can, not bother trying to change the things I can't and somehow have the wisdom to know the difference.'  So maybe that's why there are 400 people stacked up in the ER, because the hospital administrator had the "wisdom" to not bother trying to change things since it's a system-wide capacity problem.  In other words, why bother shoring up our discharge planning process when there is no where to send the inpatients anyway?  All the rehab settings are full as well.  Let the government and the lobbyists we pay good money deal with it.

At tPF, we see things a little differently.  At this time, we are working with our clients to create and develop partnering opportunities.  The historical lines that define competition don't need to be redrawn.  They need to be moved around a little bit so that competition can remain fully in place where appropriate (e.g., courting primary care physicians) and partnering opportunities can be realized in the continuing absence of system-wide (i.e., government) intervention.  No one is being asked to get into bed with the enemy.  On the contrary, what is being asked is to shift the emphasis to community service, and yes, that does mean having to talk to the other hospitals and health care settings.  The bed capacity situation is in crisis mode in many geographic areas with many other areas slowly working their way up to the same mess.  This means graduating from informal and/or ad hoc capacity discussions on possible patient transfers to a progressive geographic patient transfer plan, complete with roles, responsibilities, information-sharing, written commitments, etc.

Want to fix it?  Talk to us about our ability to bring all the key stakeholders in a given geographic area together to iron out capacity and patient-sharing wrinkles.  And then, when necessary, work behind the scenes to make corrections and improvements to a given facilities' patient flow issues, after the hospital administrator has abandoned the 'what's the use?' posture.  (He or she won't be asking this question once the value of partnering is established, roles are defined and results seen.)

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