When will hospital admin/exec/leadership walk a mile in our shoes?

[wamcp]

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Whether it’s working shifts as a hospitalist or work days in the clinic, why don’t they all do it?

Since they’re all corporate profiteers already, why don’t they see how wall street does it as an example:

https://www.wsj.com/articles/uber-ceo-started-driving-for-uber-5bef5023

Home Depot Orders Corporate Staff to Take 8-Hour Retail Shifts

Home Depot Inc. will begin requiring corporate employees to work a full day at one of its stores every quarter, a move the company said is aimed at supporting its retail staff.

www.bloomberg.com

 

[anonperson]

Whether it’s working shifts as a hospitalist or work days in the clinic, why don’t they all do it?

Since they’re all corporate profiteers already, why don’t they see how wall street does it as an example:

https://www.wsj.com/articles/uber-ceo-started-driving-for-uber-5bef5023

Home Depot Orders Corporate Staff to Take 8-Hour Retail Shifts

Home Depot Inc. will begin requiring corporate employees to work a full day at one of its stores every quarter, a move the company said is aimed at supporting its retail staff.

www.bloomberg.com

Most hospital administrators are business school rejects. Usually with online MBAs or something equivalent.

If they were actually any good, they wouldn't be hospital administrators.

They generally have no interest in getting down to the granular level of problems. A good leader/CEO would try to be forward thinking like this to improve efficiency etc.

Your typical hospital CEO wants to quietly collect their seven figure paycheck without rocking the boat.

 

[dozitgetchahi]

Most hospital administrators are business school rejects. Usually with online MBAs or something equivalent.

If they were actually any good, they wouldn't be hospital administrators.

They generally have no interest in getting down to the granular level of problems. A good leader/CEO would try to be forward thinking like this to improve efficiency etc.

Your typical hospital CEO wants to quietly collect their seven figure paycheck without rocking the boat.

Exactly.

Compounding this problem is the fact that many hospital boards are composed of local rich people who know nothing about medicine or healthcare whatsoever. So you get a situation where there’s literally multiple layers of “blind leading the blind” in hospital leadership - and usually nobody has any interest in changing that, because they all think they know what to do.

Another issue is simply greed. I think some hospital leaders do indeed know what would help doctors do their jobs better, and help improve patient care - they just don’t care to implement any of it, because it costs money.

 

[dgdg]

 

[dgdg]

Reference for the above comes from a recent NEJM article.

Saying that we can't deliver better population health in the USA because it is too expensive is, of course, rubbish.

 

[end stage fibro]

Most hospital administrators are business school rejects. Usually with online MBAs or something equivalent.

If they were actually any good, they wouldn't be hospital administrators.

They generally have no interest in getting down to the granular level of problems. A good leader/CEO would try to be forward thinking like this to improve efficiency etc.

Your typical hospital CEO wants to quietly collect their seven figure paycheck without rocking the boat.

a poet could not have said it better. more money, less accountability

~80% of my work is admin stuff. I strive to understand the granular detail you mention. when I discuss these things with the responsible admin (from individual contributor to VP level), I am shocked/disgusted with how many meetings and committees have been generated with little measurable output. I feel like when I get on a project we do 3 month's work in 1 week. You might imagine that I solve these problems because I have a chiseled jawline, penetrating insight, and am ethnic yet have no hair on my forearms. none of that is true...It's only because i bother to do the work and lookup/think about questions during the meeting, instead of "taking this conversation offline" where it vanishes into an abyss. anyone actually qualified wouldn't be caught dead in medicine...talk about a sinking ship.

edit: figured i should make this a productive comment instead of just venting. If you work at a functioning health system, you should have something called leader rounding, which is akin to what the WSJ article mentions.obviously, a hospital is not a donut factory - some corporate suit can't swing by the ED and start tubing people. however, you can spend a half day working with a person and try to see what the pain points are from an external perspective. alas, at my current shop, it seems more of a formality. People are surprised if I want to hang out for more than 15 mins. Many people i have done this leader rounding with have told me that their "leader" says they are too busy or are too nervous(!) to step into patient care areas.

 

[sloh]

Great wsj article share. So many issues are so easy to fix with a modicum of experience in the pit, attention, and intelligence.

 

[DrMetal]

U.S. spends too much because it costs too much, and b/c we don't know how to say 'No' to our patients.

Every single chest pain has to be admitted for a workup, every numbness/tingling gets a stat MRI. We've made medicine into a customer-oriented business, where the customer is always right and gets what he wants. Of course, we know the patient is not always right; they're often wrong, and that's why they're under your care.

 

[anonperson]

U.S. spends too much because it costs too much, and b/c we don't know how to say 'No' to our patients.

Every single chest pain has to be admitted for a workup, every numbness/tingling gets a stat MRI. We've made medicine into a customer-oriented business, where the customer is always right and gets what he wants. Of course, we know the patient is not always right; they're often wrong, and that's why they're under your care.

Customer oriented with the sword of malpractice litigation over our heads if anything goes wrong.

 

[anonperson]

It's only because i bother to do the work and lookup/think about questions during the meeting, instead of "taking this conversation offline" where it vanishes into an abyss. anyone actually qualified wouldn't be caught dead in medicine...talk about a sinking ship.

Lol.

Classic phrase "Take this offline"

When I was apart of the med executive committee at my hospital, that was a recurring phrase from the CMO. Like you accurately pointed out, the topic would be forgotten and never dealt with.

 

[dgdg]

U.S. spends too much because it costs too much, and b/c we don't know how to say 'No' to our patients.

Every single chest pain has to be admitted for a workup, every numbness/tingling gets a stat MRI. We've made medicine into a customer-oriented business, where the customer is always right and gets what he wants. Of course, we know the patient is not always right; they're often wrong, and that's why they're under your care.

Perhaps that is part of the problem. I cannot deny the complexity of the finances nor am I even close to an expert. For those that can afford health care here, our system can provide highly advanced medical care, but there is a great divide amongst the haves and have nots. We have far too many 'have nots'.

Published and easily searched USA health care metrics show that (as roughly demonstrated in my prior post), compared to other referenced advanced economies, we have the highest maternal mortality rate (22 deaths per 100k live births with many being intimate partner violence vs next highest being Canada at 8.5 deaths per 100k live births) and infant death rates, second highest vaginal delivery trauma rate, second highest post op DVT rates, highest missed/skipped doctor appt rates due to cost of care, highest suicide and homicide rates, obesity, amongst the lowest number of physician visits and practicing physicians per population, lowest number of hospital beds, highest rate of 'avoidable' deaths, highest rate of obesity, lowest life expectancy at birth, highest age adjusted mortality rate, highest covid-19 death rate.

Pick apart each metric as you wish, debate is good.
The overwhelming evidence is that we provide worse population health at a much higher cost. It is not entirely (or mostly) that we are spending a lot more because we don't know how to say 'No'. We don't know how to say 'Yes' where it matters for much of our population.

 

[HemeOncHopeful19]

The US doesn’t actually WANT to spend less on healthcare IMO. Sure people will say that all day but if you look at any small to medium sized city in the US the local hospital is invariably the #1-3 employer.

Fixing healthcare spending (just like higher education or defense) would put a lot of useless people out of a job and cause a recession.

 

[DrMetal]

The US doesn’t actually WANT to spend less on healthcare IMO. Sure people will say that all day but if you look at any small to medium sized city in the US the local hospital is invariably the #1-3 employer.

Quite true. And it's not just the hospital system, this is almost true in every facet of American healthcare. Ever worked in work-comp cases? Work-comp is an entire field of medicine dedicated to adjudicating peoples' (mostly) BS work related injuries. The excessive workups and treatments (including expensive surgeries, oftentimes for chronic conditions loosely related to the mechanism of injury) probably accounts for a good fraction of our excessive healthcare costs.

But, we allow it, maybe even thrive on it.

'Merica!

 

[dozitgetchahi]

Perhaps that is part of the problem. I cannot deny the complexity of the finances nor am I even close to an expert. For those that can afford health care here, our system can provide highly advanced medical care, but there is a great divide amongst the haves and have nots. We have far too many 'have nots'.

Published and easily searched USA health care metrics show that (as roughly demonstrated in my prior post), compared to other referenced advanced economies, we have the highest maternal mortality rate (22 deaths per 100k live births with many being intimate partner violence vs next highest being Canada at 8.5 deaths per 100k live births) and infant death rates, second highest vaginal delivery trauma rate, second highest post op DVT rates, highest missed/skipped doctor appt rates due to cost of care, highest suicide and homicide rates, obesity, amongst the lowest number of physician visits and practicing physicians per population, lowest number of hospital beds, highest rate of 'avoidable' deaths, highest rate of obesity, lowest life expectancy at birth, highest age adjusted mortality rate, highest covid-19 death rate.

Pick apart each metric as you wish, debate is good.
The overwhelming evidence is that we provide worse population health at a much higher cost. It is not entirely (or mostly) that we are spending a lot more because we don't know how to say 'No'. We don't know how to say 'Yes' where it matters for much of our population.

This is attributable to multiple layers of problems:

1) the US healthcare system has allowed lots and lots of rent seeking middlemen to enter into the market and get their cut. Some analyses attribute 30-40% of US healthcare costs to profits from all these middlemen companies, as well pharmaceutical and device manufacturers, hospital executives, etc etc.

2) The US population is generally unhealthy, and US culture is heavily emphasizes engaging in unhealthy and harmful behaviors that lead to health issues. I don’t think I need to elaborate there.

3) There is absolutely an issue with healthcare distribution. If you’re a upper middle class white person living in a suburb of a major US city, you’re likely getting high quality healthcare. However, if you’ve ever worked with rural, non-white, LGBT, or urban impoverished patients you know exactly why those numbers suck as much as they do. We deliver great healthcare to a fraction of people, and complete garbage healthcare to everyone else. Practicing medicine in the rural south was a huge eye opener for me.

3a) Most of the excessive healthcare is delivered to “those who can afford it”, although there are other huge unnecessary/preventable healthcare niches. Workers comp was mentioned, and I would agree there. Disability is another. Anyone who’s ever worked at a VA knows that the vast majority of issues you treat there have nothing to do with military service. Another is having to deal with (let’s just be honest) the somatic complaints of crazy patients, most of which are just bogus - but we end up going down a wild expensive goose chase just to tell someone that we can’t find any organic reason for their symptoms.

4) Because of issue #2, US healthcare is heavily reactive rather than preventive. We have a lot of phenomenal capabilities in tertiary care in the US, but so many of those capabilities are focused on rescuing people from issues that could/should have been averted way before they happened. We have made more of an effort towards preventive care of late, but we still have a long way to go, and a lot of the issue is still cultural. (For example, I still see waaaaaaay too many patients who come to every visit reeking of cigarette smoke despite all their healthcare providers for years telling them to stop. We still have something like 15-20% of the US population smoking tobacco (and now pot), which is way to freaking high.)

 

[CptNemo]

U.S. spends too much because it costs too much, and b/c we don't know how to say 'No' to our patients.

Every single chest pain has to be admitted for a workup, every numbness/tingling gets a stat MRI. We've made medicine into a customer-oriented business, where the customer is always right and gets what he wants. Of course, we know the patient is not always right; they're often wrong, and that's why they're under your care.

Agreed. It is very difficult as the system does not incentivize saying no.

Patient requests an inappropriate study or treatment:
Scenario 1: You spend a large amount of time talking to the patient, telling them why the course of treatment is not indicated and tell them that you won't order it.
-Patient rates you poorly on the hospital system's satisfaction survey claiming that you don't listen to them. Then admin gets on your case.
-The patinet keeps sending you inbasket messages.
-You end up spending more time with them and billing the same amount
-If something bad happens (if by chance they have some unlikely pathology going on), then they will blame you and sue you - they'll probably lose if you were practicing in line with the standard of care, but at best, they can make your life painful - at worst, they may prevail with our crazy legal system...

Scenario 2: Just do what the patient wants and move on.

 

[DrMetal]

Agreed. It is very difficult as the system does not incentivize saying no.

Patient requests an inappropriate study or treatment:
Scenario 1: You spend a large amount of time talking to the patient, telling them why the course of treatment is not indicated and tell them that you won't order it.
-Patient rates you poorly on the hospital system's satisfaction survey claiming that you don't listen to them. Then admin gets on your case.
-The patinet keeps sending you inbasket messages.
-You end up spending more time with them and billing the same amount
-If something bad happens (if by chance they have some unlikely pathology going on), then they will blame you and sue you - they'll probably lose if you were practicing in line with the standard of care, but at best, they can make your life painful - at worst, they may prevail with our crazy legal system...

Scenario 2: Just do what the patient wants and move on.

Yup, Scenario #2 is the way to go. I love it when they ask for acupuncture and Aqua Therapy.

 

[shouldigomd]

We as physicians have allowed healthcare in America to evolve into a machine where everything is controlled by corporate executives. I mean each hospital has a CEO, CFO, CAO, CMO, etc etc etc making decisions about healthcare. I think the saddest thing is while these exec's extract huge salaries (while being relaxing at home by 3pm on Friday afternoons) and insurance companies cause inflation of prices where basic testing costs over 10x the actual cost .... patients and the public think physicians are the ones making crazy $$ and out to screw them.

 

[chessknt]

We as physicians have allowed healthcare in America to evolve into a machine where everything is controlled by corporate executives. I mean each hospital has a CEO, CFO, CAO, CMO, etc etc etc making decisions about healthcare. I think the saddest thing is while these exec's extract huge salaries (while being relaxing at home by 3pm on Friday afternoons) and insurance companies cause inflation of prices where basic testing costs over 10x the actual cost .... patients and the public think physicians are the ones making crazy $$ and out to screw them.

Allowed? When has anyone seriously asked what we think should happen and actually done it. The system is controlled by private equity and business overlords extracting money from all involved who buy politicians because that is what America is now. Hospitals/insurance>pharma>medical devices all swimming in oceans of money. We show up in clown costumes to lobby and make for good photo ops but in real life we are a goldfish in the Amazon to the people actually in charge of health care.

 

[DrMetal]

at home by 3pm on Friday afternoons

To be fair, I (a rounding hospitalist) am home (or on the front 9) most days by 3 pm. It gets easier as you start caring less.

 

[shouldigomd]

Allowed? When has anyone seriously asked what we think should happen and actually done it. The system is controlled by private equity and business overlords extracting money from all involved who buy politicians because that is what America is now. Hospitals/insurance>pharma>medical devices all swimming in oceans of money. We show up in clown costumes to lobby and make for good photo ops but in real life we are a goldfish in the Amazon to the people actually in charge of health care.

Yes, exactly my point. Physicians have evolved from respected leaders of the community to pawns of corporate America.

 

[WIFEL585]

I enjoy reading threads bashing administrators in general. Working both inpatient and outpatient has shed a lot of light into the way real world medicine works in America, in a way that you simply don’t learn in medical school / residency. I’ve never come across an administrative person who appeared smart, well educated or likable. IMO they’re all fairly annoying and talk too much. It’s also why I enjoy not working for a group / clinic / hospital - not having to deal with these people the way a salaried employee does.