Sunday, April 25, 2010

Non-zero sum

Let's face it. Health care is an odd field. Costs are unknown or indecipherable. Prices for the services offered are hidden from consumers. Likewise, the value (efficacy, quality, safety) of the services received is hidden from consumers. In no sense does it represent other markets, in which transparency of these elements reigns and which therefore have a better chance of reaching the "efficient market" described by economists.

In such an environment, growth in market share by one participant is usually solely at the expense of another: a zero sum game. But even in the dysfunctional world of hospitals and physician marketplaces, such transactions can add value to society. In that case, the result is a non-zero sum game. But only if the "winners" actually do add value.

The business strategy of our hospital is remarkably straightforward. We hope to be the high quality, low cost provider among academic medical centers in our region. We look for community-based partners -- hospitals and physician practices -- for whom we can respectfully help to deliver coordinated care. You have read numerous examples on this blog about how we are trying to do this.

But this is more than a business strategy. It is a matter of values and mission. You won't find this mission statement written in our formal documents or in any strategic plan. Its strength lies in the fact that it is a deeply held belief.

I never told you this story, but when Gloria Martinez, one of our transporters, won our first caller-outer-of-the-month award, she first graciously accepted the award on behalf of herself and the other transporters. Then, with no coaching or prompting whatsoever, she said that she and her colleagues viewed their job as "trying to provide the kind of care we would want members of our own family to receive."

I know I do not violate confidences when I tell you that this simple statement from Gloria left tears in the eyes of our Board members. That a person who pushes beds and wheelchairs and delivers specimens -- who in another institution might be anonymous and ignored -- could simply and elegantly express the community purpose of our hospital was a very moving moment.

We fully engage clinical transparency because we view openness in such matters as the best way to hold ourselves accountable to the standard of care we -- the Board, the clinical leaders, and the administrative leaders -- have set for ourselves. We do not do this for competitive purposes, but if the health care marketplace recognizes our progress and rewards us with a growing market share, we are happy to contribute to a non-zero sum result for society.


Anonymous said...

As a non business person, I find it laughable that others would think you were “just” trying to gain competitive advantage with your quality/transparency efforts. If that’s true, then you must not be very good because you picked the absolute hardest way to do it.

What a business strategy – throw up all your quality statistics, good and bad, including a sentinel event – for all to see, solely to gain market share. Post your Joint Commission inspection results online. So now, having set the precedent, you have to continue to post these results even if they decline. Oh, and for good measure, give speeches including phrases like “killing and maiming” in hospitals.

So with that in mind, I hope whoever made that criticism takes a lesson from the fact that your transporter of all people, knows, really KNOWS, why you are all there in the first place, and lives that out every day. Yeah, some lousy business strategy.


Anonymous said...

The real business strategy here is the design of a system that propels a transporter to call out obstacles to quality patient care, and to expect to be heard. And the real business courage is to do battle with static hierarchies which omit employees and patients as stakeholders in hospital operations. Internal transparency is a powerful tool.

Kymus Ginwala said...

I have been reading your blog with much interest and respect. The story of Gloria Martinez reminds me of a visit I made many years ago when I was running a technology company in the Boston area to the Honda Manufacturing Company in Ohio. Honda was, and still is, very well known for its quality and was always ranked first in the JD Power survey. He made the point that Honda had only six job descriptions in its entire factory while Detroit felt it needed hundreds. He said that even if you asked the cleaning staff who would clean the restrooms what their job was they would say that " it was to ensure that Honda was Number One on the JD Power annual survey of customer satisfaction".

Anonymous said...


Are you going to comment on the ongoing news coverage related to some past "poor judgement" on your part? It would seem to be in line with the values of transparency you promote. We're all human.


Anonymous said...

Sorry, but my only comment is in the email that I sent to the staff, which you have seen and which is quoted in the newspaper stories. I have had long-standing policy of not discussing personnel matters here.