Monthly Archives: June 2014

The New C-Suite in Health Care

Health care version 1.0, run by physicians and other providers, did not work due to an unrestrained utilization of resources.  Health care version 2.0, run by corporate forces, also has been a failure.  For the past several decades the focus in health care has been about the business of health care.  A model of corporate medicine has emerged and proliferated and it only works well for those whose job it is to manage the bottom line.  Now we are told (finally) that the future of health care is value.  And we are told that the numerator and denominator of value are quality and cost respectively.  In theory this will be a transformational change in health care that will require a complete overhaul in operations.  But unfortunately nothing is happening at the front lines.  Most likely because those currently in charge know nothing about quality but rather are business people.  A meaningful change in health care will begin with a substantive change in leadership.

  1. CCO: Chief Cultural Officer.  The most important person in the C-Suite.  The CCO will be the relentless agent of change.  The CCO will establish the environment where quality care happens.  A Donabedian disciple of quality who realizes that structure and process guarantees nothing.  Care will always be patient focused.  Care will always be evidence based.  Sets the standards and acts as a role model for providers at every level of the organization.
  2. CAO: Chief Alignment Officer.  The CAO will serve as the intermediary between quality and cost.  Understands the importance of the bottom line which is second only to great care.  Will interact with and align the providers with the payers and others whose job it is to maintain the bottom line.  Will share information between the two sides on an ongoing basis so that the value equation is maximized.
  3. CPO: Chief Practice Officer.  Possibly the most difficult job on the list.  The CPO will be responsible for transforming the practice of medicine.  The current model will be deconstructed and rebuilt.  The medical staff will first and foremost be dedicated to evidence based practice and will be provided with all of the time and resources to do so.  All unnecessary and ineffective processes will be eliminated so that providers can use that time for better purposes.  It’s not about compliance anymore.  The future will be about a medical staff that is self-motivated to be the best that they can be and doesn’t need high-priced babysitters to follow them around checking boxes on paper.  The CPO will make sure that their medical staff is functioning at the highest possible level.  The CPO will also assure that they medical staff will make every decision based upon the patient’s best interest.  Always.

There will be additional new and innovative positions designed to completely change health care.  These positions will all be held by physicians who have demonstrated a selfless commitment to patients and the profession.  They must be innovators.  Incremental change won’t work.  Lastly, they must be courageous.  For several decades health care has been shaped and managed by non-physician administrators who now will need to be displaced.  Someone will need to help them see how little they actually contribute to the process of delivering health care.  They won’t go quietly.  There will be an incredible amount of self-preserving rhetoric.  Keep the focus on patients, quality and care and the good guys will persevere.

The new C-Suite will meet regularly with community members to receive feedback and assure that the new model is meeting the needs of the people that they serve.

So hopefully a complete change at the leadership level will result in the transformational change in health care that is necessary: The transition from the emphasis being placed on volume to the emphasis being placed on quality with the result being value.  This isn’t bad news for everyone currently in the C-Suite.  Will keep the CFO.  Someone needs to understand how to depreciate equipment 🙂

Bring Your Administrator to Work Day

They don’t understand.  They can’t understand.  They probably would rather not understand.  Health care administrators and managers and insurance executives can’t understand what it is like to provide health care face to face with another human being.

The training of health care administrators, managers and insurance executives is based on spending two years in business school studying topics such as accounting, finance, marketing, human resources and operations management with some electives in an area of concentration as well.  The goal of this training is to eventually sell something to someone.  The product is irrelevant and the focus is always on the bottom line.  Any human interaction is a means to an end.

In comparison, physicians spend a minimum of seven years in training (often more) and in general all but the first two years involve daily contact with other human beings who have a potentially serious health concern.  The goal of this training is to deliver quality health care. Human interaction and relationships are the foundation of the profession.

To a business school graduate the product doesn’t really matter.  The unit of production is irrelevant.   Make as many as you can as cheap as you can and sell them at the highest possible price.  Time and people are expenses that ideally are minimized.  No time for a relationship in this model.  The mentality is that health care can and should be sold and delivered just like any other product or service.  In fairness,  health care was in need of efficiency however this grind has passed the point of diminishing returns.  Cost cutting at the level of care delivery is now compromising the ability to deliver quality health care.  And sadly patients and physicians have accepted the current model.

Physicians are well aware that health care can not be managed like any other abstract unit of production.  Health care is based on a relationship between a patient and a physician and relationships take time.  In addition, the relationship time is usually different for each patient.  The training is long and difficult for a good reason.

Alignment is a hot topic right now.  Physicians, other providers, hospitals and insurers must all be working together to deliver value focused health care.  The adversarial and antagonistic atmosphere that exists must be eliminated before the health care system will improve.  Two years of business school, or even a 20 year career in an administrative suite, can not begin to allow a health care administrator or manager to understand what health care is like on the front line of health care delivery.  Therefore, HCR is proposing that all administrators, insurers and managers be required to spend time with physicians and other providers.  A busy day in the office or operating room.  Administrators need to see close-up the human interactions that are such an important part of quality health care and that can not be streamlined like an assembly line.  And they need to watch it all as if the patient was one of their own family.  Would an administrator who spent the day with a busy oncologist really wonder why he/she can’t see 5 more patients a day after watching him/her spend 45 minutes with a young mother just diagnosed with cancer?

And maybe to be fair health care administrators and insurance executives can have a “Bring Your Doctor to Work Day”.  Guess is that providers would be able to review with them all of the people and processes that cost money and do nothing to make care better.