Friday, December 16, 2011

What they say versus what they do

I thought it might be instructive to compare the various wordles below, showing the strategic priorities of the hospitals, with what the CEOs say are their priorities.  So, I took this chart of top issues hospital CEOs say they face from a while back and made a wordle out of it.  I rounded off the percentages and repeated the word in the wordle application one time for each ten percentage points (e.g., MD/hospital relations at 25% became 3).  Here's what you get:

Now, compare that with any of the ones below.  Here's Emeline's, representing a number of academic medical centers, to remind you:

Hmm, seems like there is not much correspondence between corporate missions and how leaders spend their time.


clsmt said...

I think there's a difference between one's challenges and one's goals. The size of the word finance in the first wordle is the reason why financial incentives and penalties are so powerful.

Paul Levy said...

Actually, not so. If you look at the experience with financial incentives and penalties, I think you will find very mixed results. For example, wrong-site surgeries have been classified as "never" events, with payments not permitted. Yet, the rate of such wrong-site surgeries has remained quite constant.

Incentives and penalties are essentially meaningless to those actually involved in the delivery of services on the hospital floors and in the units. The way to achieve excellent financial results is by reorganizing the work of hospitals to reduce waste and inefficiency and improve the quality and safety of care.

Nancy said...

It's the sadness of the whole country vs those who are leading or, should I say, making decisions.
One is about money. One is about caring.

e-Patient Dave said...

I had the same thoughts as cslmt - that one's mission is not always what one must spend one's time doing. But then this struck me: isn't a strong leader supposed to have people "doing the doing," so the leader can remind people of the mission?

And if what the leader talks about is not the mission, then that would indeed be a disconnect.

(That's a question - I've never run an enterprise.)

Anonymous said...

e-Patient Dave, you are too modest. Running a business, as my father would say, is the easy part. Numbers. Just numbers. Ideas, movement: that is another thing.

Each time that I step on a plane, in a store, or a hospital - and the seat is closer, the line is longer, the doctor more distracted, the employee more defeated, I think that the numbers might just be a little up that day. The FINANCE in caps is fuller, someone's vacation more exotic. But most of us just feel crowded and used.

And mission statements? Well, they start to look like the same billboards we've passed for the last three hours since we hit the desert (if you know, you know). Quality and safety, is that the rest stop we just passed, or the town next ahead? Who knows?

If you say you care, but everything after you enter the door is ambivalent - you've already said it all. It is called a tradeoff. And there is no marketing that can help you to avoid it. People, yes, are easily fooled. But they can also walk. Trust is the most difficult capital to gain, or to replace.

e-Patient Dave said...

Thanks for the kind words, anon 12:47, but when I said "I've never run an enterprise" I wasn't talking about difficulty, I was just noting that I've never walked in those shoes.

It's analogous to how many people in policy meetings say "We don't need to bring patients in - we're all patients someday, right?" Well, no; I can say first-hand, until you've been in Great Big Crisis, life-changing with major potential to go either way, you do NOT know what "the patient perspective" really is.

Point taken, anyway. Yes, it's a tradeoff - which is why vision and leadership really are important. If all people hear about is finance, it colors the decisions.

Finance needs to be manage or you end up in a situation like BIDMC in 2000.