Monday, April 11, 2005

The Toughest Management Job?

I am convinced that running a hospital must be one of the most frustrating management jobs on earth. That’s because the ordinary laws of supply and demand often vanish, and hospital managers then operate in a bizarre environment where “customers” expect state-of-the-art service, they expect it now, and they expect it for free. After all, customers themselves rarely pay for their health care services. A third party, like an insurer, does—which totally distorts the economics. But if that’s bad, just wait; it gets weirder.

Here’s what hospital administrators have to deal with. A gangbanger is brought into the emergency room at 2 a.m. suffering from multiple gunshot wounds. A half hour later a woman who doesn’t speak English and is in the U.S. illegally is brought in ready to deliver a baby. What do these two individuals have in common? They both know that they’ll never pay the hospital a dime, and the hospital knows it too. But what can the hospital do other than to give them state-of-the-art service, and then sometimes later try to recoup some of the losses through innovative bootlegging of other income?

I am always amused at the presumptuousness of motivational speakers who tell audiences of healthcare providers to go to places like Nordstrom and Ritz Carlton to learn how to deliver customer service better. Earth to speaker: the great service at Nordstrom and Ritz comes with a big fat price tag. Try going to Nordstrom and pointing to a pair of $300 shoes and saying: “I don’t have the money to pay for those shoes, but I deserve them because I’m an American.” Try checking into the Ritz Carlton with that same attitude. How quickly do you think you’d be escorted out by security in both places? Yet this is the mindset we Americans often have when we approach health care.

Our health care system is fabulous in many ways. Over the past three days, providers at my father’s HMO located the exact spot in his artery that was 99% clogged, performed an angioplasty, inserted a stent, and did it all with efficient professionalism and gentle courtesy. I am utterly amazed, and grateful.

But our health care system is also sick. Activists talk about the 45 million uninsured Americans, which is indeed a national disgrace. But we also need to talk about our attitudes of entitlement, the kinds of attitudes that say any American deserves any treatment at any time without considering how it’s going to be paid for, and by whom. Until we come to grips with that reality, I don’t know how we can possibly “fix” health care in this country.

Meanwhile, as you read this, remember that the hospital nearest you is humming along, available to you 24/7, 365 days per year, facing situations that leaders in other industries would consider an economic nightmare. The fact that we’re still getting good people in health care management roles is a minor miracle. God bless ‘em—and the doctors and nurses and technicians too.


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