Well, it is clearly the end of the semester, as I am being invited for interviews with many graduate students who are finishing term papers. Even more interesting is that the papers seem to be centering around mergers, as indicated yesterday and repeated today in a conversation with three graduate students at the Harvard School of Public Health. Here they are: Marianne Jurasic, Katie Sullivan, and Ryota Konishi.Perhaps the topic is of interest because people feel that Accountable Care Organizations are likely to result in consolidation of hospitals over the coming years. These students were investigating the impact of hospital mergers on organizational culture, using the merger of New England Deaconess Hospital and Beth Israel Hospital as an example. They interviewed me after having heard from HR organizational development specialist Joanne Ayoub and RN Mary Ellis.
As I have noted before, the late doctor Richard Gaintner used to refer to the Deaconess as, "A place where science and kindliness unite in combating disease." That could just as well have been applied to the BI. Given that commonality of values, it is ironic that there were some difficult years immediately following the merger in 1996. The job of the CEO in such a situation is to reinforce mutually held underlying values and help build a new sense of community in the newly combined organization. At BIDMC, the underlying culture of the two antecedent institutions ultimately prevailed, with a clear consensus around a purpose -- caring for patients the way we want members of our own families to be treated, while advancing humanity's ability to alleviate human suffering caused by disease.
I think an even more critical merger than that of different hospitals, is going to be the merger of doctors and hospitals as part of ACO's. This will be the mother of all merger challenges in terms of merging culture and developing trust. I hope, for patients' sake (and remember as epatient Dave says, 'patient is not a 3rd person word') that both parties understand this. It would take someone with all of your skills and natural talents, Paul, to even begin to address a challenge of this magnitude. I fear for our future.
ReplyDeletenonlocal MD
Culture change is inevitable given the thrust of responsibility that we are laying on both doctors and patients. The defiance and backlash are predictable, but doctors who are tired about hearing about 'process' and 'improvement' and 'checklists' and 'mechanized medicine' are missing the bigger implications of the inadequacy of traditional medical worldview.
ReplyDeleteSee the ads: 'Comprehensive Cardiovascular Care' (how is this organ-centered focus comprehensive?) and 'Coordinated Cancer Center' (Are they also advocating for contaminate reduction in the community?). The god complex trained from medical school on (observe how residents speak - or do not - to nurses 20 years their senior) stifles the ability to see how self-promotional the enterprise is. This lack of visible engagement of the medical community in CREATING health is a spectacular failure.
Patients now responsible for more of their bills, and faced with increasingly frustrated doctors who can't seem to change their behavior, will take their money and health elsewhere, alternative care, the competitor with the "Wellness Center" and lunch-time exercise classes in the community, or not show up for appointments altogether.
I agree with nonlocal MD, the magnitude of the change ahead will require more spectacular leadership than medicine at large has demonstrated it can provide.