Change, People, and the Bottom Line
If ever there was a time when the health care environment caused many employees to feel as though they were no more than another cost of doing business, the present is likely to be that time. As health care workers everywhere awaken to the hard fact that health care is being changed by forces largely beyond their control, it becomes more apparent that significant change in health care will continue to alter the way many of our health care organizations function. Much of this continuing change disturbs long-held paradigms so severely that some people who are affected may simply leave health care.
Health care organizations are continuing to change in size, complexity, structure, and scope of service. Some organizations of traditional forms are vanishing; new organizations of forms unanticipated not too long ago are proliferating.
Much of what lies in the future for health care workers remains unclear if not unknown. However, it has been apparent for some time that the emphasis on inpatient care will continue to diminish. The hospital as a provider of inpatient services is steadily becoming a less significant factor in health care delivery. This suggests a major collision with one of the health care paradigms that pertained for years: the acute care hospital will always be the center of the health care system. So strongly held has this belief been that we still tend to see most other forms of care as extensions of or adjuncts to the acute care hospital.
Another paradigm under constant assault is the cost-quality paradigm, the belief of many in health care that cost and quality exist in a direct relationship to each other: that one cannot reduce cost without reducing quality. In these days of constant cost-control demands, one cannot discuss the subject long before hearing, from clinical and nonclinical personnel alike, that curtailing certain expenditures will negatively affect the quality of care.
For a variety of reasons, most having to do with escalating costs and various payers' relative ability to pay, health care has come under intense bottom-line scrutiny. And a great deal of what has all along occurred in nonhealth organizations has come to bear in health care organizations. All too often it seems that as emphasis on the bottom line increases, apparent concern for people-employees in particular-decreases.
A bottom-line focus is of course essential to survival; the organization that consistently loses money will no longer exist to provide services to anyone. On the other hand, a positive bottom line may do little good, or it may vanish quickly if motivated people of healthy morale and with a reasonable sense of job security are not on hand to permit the organization to function. What is happening in these days of mergers and reengineering and such is that the bottom line sometimes receives a disproportionate amount of attention while people concerns are left behind.
Today's executives include an increasing number of "tough" managers who may sometimes be referred to as change agents or turnaround specialists. Some seem well suited to the task because they can readily lay off employees without being appreciably bothered by doing so. After all, the bottom line dictates.
What is needed, of course, are rational reengineering processes that look at the budget for next year and the years beyond-not just looking for what can be saved this year-and that balance bottom-line concerns with concern for people, recognizing that ultimately it is people that drive the bottom line.
This issue of The Health Care Manager (33:3, July-September 2014) offers the following articles for the reader's consideration.
* "Enhancing Learning, Innovation, Adaptation, and Sustainability in Health Care Organizations: The ELIAS Framework" presents a practical performance management framework that can be utilized to develop sustainable health care organizations, a multistep process premised on accountability, performance management, and other foundational elements.
* "Analysis and Recommendations for Reducing Risks of Patient Cross-Contaminations via Noncritical Medical Devices" addresses the problem of health care-associated infections and provides insight into likely source of cross-contamination, probable causes, and identification of areas for additional investigation.
* "New York's Health Care Workforce Recruitment and Retention Act: An Investigation of the Effects of Nonrecurring Increases in Health Worker Wages on Health Worker Supply" analyzes this particular legislation for its intended effects and actual results and provides suggestions for future directions in supporting recruitment and retention.
* "Dimensions of Quality Care Affecting Career Satisfaction of Pediatricians" reports on an investigation of factors affecting career satisfaction among pediatricians and further identified specific factors having negative effects on career satisfaction.
* Case in Health Care Management: "The New Broom" asks the reader to address the apparent difficulties encountered by a newly placed manager whose initial efforts emphasize the need to bring what appears to be a slack operation quickly into line with existing policies.
* "Foundation of Evidenced-Based Decision Making for Health Care Managers-Part II: Meta-analysis and Applying the Evidence," in following up on part I, which defined systematic reviews and outlined the process of conducting them, explains the additional procedures associated with meta-analyses and describes the potential shortcomings of both systematic review and meta-analyses.
* "Foreign Trained Nurses' Experiences and Socioprofessional Integration Best Practices: An Integrative Literature Review" examines the evidence available concerning obstacles and facilitating factors involved in the socioprofessional integration of internationally educated nurses and endeavors to identify best practices concerning their workforce integration.
* "Medicare Fraud in the United States: Can It Ever Be Stopped?" reports on a research study undertaken to explore the current state of Medicare fraud in the United States, identify policies and laws that foster such fraud, and assess the financial impact of Medicare fraud.
* "Factors Influencing Consumer Satisfaction With Health Care" reports on a study undertaken to examine factors that impact consumer satisfaction with health care, addressing treatment issues, financial issues, family-related issues, sources of health care information, and other factors of relevance.
* "The Affordable Care Act: The Ethical Call to Transform the Organizational Culture" suggests that the successful health care organizations and health care systems of the coming years will be defined largely by their adaptability in the new value-based marketplace created by the Act.