How many times have you said the last 12-plus months have been a tough year? Hundreds, if you’re like me.
With the public rollout of COVID-19 vaccinations, we are starting to glimpse some light at the end of the COVID-19 tunnel for the first time in over a year. Although some parts of the country and the world have seen spikes in new cases, healthcare leaders in many parts of the U.S. are now turning their attention to the structural and financial challenges that the pandemic laid bare.
These leaders are now tasked with taking lessons from the past year and using them to modernize their approach to acute care delivery. COVID-19 pointed out our weaknesses, and key among them are untenable cost structures, poorly performing legacy technologies, lack of agility, failure to adopt proven technology and overwhelming amounts of data producing underwhelming insights.
Our healthcare system is constructed to deliver care in a different era, the equivalent of the Maginot Line in the early mid-20th century. Using the lessons of war from a generation prior, the French spent mightily to create a system of defenses that were instantaneously obsolete. An unwillingness to learn or change left French fortifications vulnerable to a new strategy of waging war that favored swiftness and mobility over stout fixed defensive positions.
As healthcare leaders, we must not fall victim to the same ignorance, stubbornness or ennui lest we fail to do an appropriate postmortem of our response to the pandemic and develop a strategy that will provide hope for a better outcome the next time we face a similar threat. There needs to be an embracing of breaking out of the status quo. The administrative side of the house, like the Maginot Line, is bloated, inefficient, change-averse, and lacks resiliency and agility. Clinical operations experts need to be empowered to determine the resources necessary to deliver equitable, high-quality, lower-cost care.
So, what will it take to better prepare us for the future? Healthcare systems, including hospitals, need to pull a Dewey Oxburger. Dewey, John Candy’s role in the 1981 movie "Stripes," was a lovable, mild-mannered, overweight and out-of-shape army recruit who enlisted to become a “lean, mean fighting machine.” Along the way, he learned some skills that are appropriate to today’s healthcare systems: dieting, belt-tightening and commitment.
Making it on Medicare (the diet)
Despite being pushed to the brink of collapse by wave after wave of COVID-19 patients and experiencing the most significant curtailment in elective and non-emergent care that we have seen in 50 years, more bad news awaits care settings. American hospitals must now come to terms with the inevitable fallout from the Price Transparency Rule. It will not be long before consumer-friendly solutions reveal the unsustainable variation in price for healthcare services, without regard for quality.
U.S. health systems will now need to justify cost differentials compared to competitors, which will result in downward pressure on annual rate increases. It is time that health systems develop and implement initiatives to get to a positive margin on Medicare to survive.
Quality and customer service maximization (belt-tightening)
Part of “making it on Medicare” will require a reduction in headcount somewhere in the organization. This can be done by a reduction in recruitment where feasible, but ultimately a total reduction in FTE will be necessary. Fortunately, technology now exists to automate a lot of the administrative burden plaguing healthcare systems. Robotic process automation and artificial intelligence are delivering multiple solutions that alleviate mind-numbing and repetitive tasks that a computer is optimized (compared to a human) to execute.
A reduction in force, alone, is not sufficient. We must simultaneously invest in individuals that have the skills and training to most efficiently and empathetically manage the more complicated tasks. This seems counterintuitive. However, while human capital is expensive, value is created if it is deployed in a way that enables humans to work at the top of their training.
Health systems need to invest in human capital where it makes sense and invest in technology only when a computer can enhance the work of a human being. By allowing computers to do what they do best, we can better support humans in doing what they do best, managing complex tasks for comorbid patients. By doing this, quality and customer service can actually improve while simultaneously reducing operating costs.
Commit to the cause (diet adherence)
Dewey didn’t trial a diet to get into shape, he joined the Army because it “had a training program … a real tough one.” If we want healthcare to work more like the rest of our consumer-oriented lives, then leaders must be willing to commit to real change.
C-suite leaders need to commit to their operations experts. Give them the training, decisional power and the dollars to invest in waste reduction and operational improvement. Help them bring in the best in breed solutions as well as some new entrants to understand not just what they can do, but what is possible. Inspire those on the front line to do the right thing and more often than not, they will.
A commitment to data is also a must. Hospitals are awash in data but have a dearth of insights. Front-line caregivers and administrators are flying blind while the data warehouse is full of data that can be used to improve care, reduce cost and, most importantly, predict.
Lastly, commitment to truly understanding patient journeys is mandatory. Not just an isolated experience when they are in a hospital bed but the end-to-end experience that includes both in- and out-of-office encounters. You will find out that you have been measuring the wrong thing and investing in solutions to the wrong questions.
It’s been tough of late, sure, but there is reason to be optimistic. Don’t we owe it to ourselves to pull a Dewey Oxburger?
Adam Silverman is the chief medical officer at Syllable. He has 30 years of experience as a physician and executive and a diverse work history that includes private practice, academic medicine and physician leadership in both hospital and ambulatory settings.