posted by dls at 6:04 am
The November/December edition of the Journal of Healthcare Management has a brief piece on the role of leadership in patient-centered care.
The article reminded me of an experience we had with a client. At the time the client was losing a great deal of money on their skilled-nursing unit. There had been an ongoing argument about whether to close it. On one side of the debate, people argued that the hospital should not abandon patients that needed something from them. They argued that the answer to the problem was to figure out how to run it more efficiently, so that they could maintain the service. On the other side of the debate, they argued that closing it was the most responsible thing to do: no margin, no mission. The skilled unit was diverting resources away from other important priorities in the hospital.
In a way, you can argue that both sides of the leadership’s disagreement (this included the board) were concerned about patients.
But as we facilitated this decision-making process, we uncovered that this was only half true. Both had a concern about patients, but neither group had actually put real patients and their needs at the center of the debate.
My job, as it always is, was to keep them not just focused on being patient-centered, but forcing them to figure out how to operationalize this wonderful idea–since that’s all it was at this point. In our work, we ensure that decisions start with the moral dimensions of healthcare: how do we do the right thing for each of our patients. In a way that we can afford, of course.
We helped the group investigate the financial issue through the lenses of meeting each individual patient’s needs exactly. In reviewing previous charts and looking at their current patients, with an eye to exactly what each patient needed, they found 28 of 29 patients really needed something other than their skilled unit. And the 29th was from two hours away–in between the hospital and her home were several SNFs (skilled nursing facilities) that would make life a lot easier on her family.
Once patients on the unit were placed where they truly belonged, the unit was empty. Operationalizing the slogan “patient-centered care” eliminated the dispute. No longer were they just arguing their side and tacking on, “for the sake of patient-centered care.” Patient-centered care had guided their entire decision-making process.
There are many other terrific details of this story, but–cutting to the chase–redeploying staff and closing the unit were, according to the CEO “kind of anticlimactic.” “No drama,” the CFO said. “Just the way I like it.”