From the Editor

RobFromberg_2012_r1 Robert Fromberg, Editor-in-Chief

I love a good story about a bad decision.

I'm reading The War for Late Night, about the decision to move Jay Leno from his successful spot hosting The Tonight Show at 11:30 p.m. to a five-day-a-week slot in prime time.

NBC management was admirably proactive. Five years ahead of time, NBC got Leno to agree to end his successful run hosting "The Tonight Show," and Conan O'Brien would move into that role from his hosting duties on "Late Night," which aired immediately after Leno's program. At the time the arrangement was made, Leno's ratings were strong, but management worried those ratings would fade, and they didn't want to lose O'Brien, whom they believed was the future of late-night television.

But when the deadline finally arrived for the transition, things didn't go as planned. Leno's ratings still were strong. And rather than go off into the sunset of retirement, Leno considered going to rival ABC and taking his ratings with him. Rather than face that competition, NBC suggested option after option to Leno for keeping him at the network, finally opting for the network's last resort: wiping out its entire 10 o'clock lineup and inserting a Leno program five nights per week. At that point, everything went wrong. O'Brien's ratings were disappointing, Leno's new program was a flop, and the NBC affiliate stations were on the brink of open rebellion. In an effort to put Humpty Dumpty together again, NBC management tried to move Leno's program back into his old time slot, creating bad blood with O'Brien and his fans, and leaving NBC the subject of widespread ridicule.

Decisions about late-night TV may seem worlds away from those of healthcare organizations trying to reshape their relationships with physicians-the focus of this issue of hfm-but just three lessons from the NBC late-night experience shed light on how to ensure big decisions about integration are not big, bad decisions.

People are not chess pieces. Leno-well-known for being a workaholic-didn't want to retire. And O'Brien-well-known for his outlandish humor-didn't reshape his new show for a broader audience. It is wise to consider a person's true nature when trying to predict his or her behavior. For hospitals seeking to integrate with physicians, understanding the true nature of specific physicians will be key to working effectively with physicians who represent a range of different attitudes toward integration.

You cannot have everything. NBC wanted both Leno and O'Brien. But that was impossible, and NBC's machinations to try to keep them both were embarrassing and destructive. No matter how much stature and referral power a physician or physician group has, it may not be possible to work with everyone in a way that will yield high-value care for the hospital and its constituents.

If a decision is your last resort, it is probably a bad decision. Once NBC decided to move Leno to 10 p.m., many network leaders convinced themselves it was a good decision. But the reluctance with which the decision was made should have been a signal of impending disaster. Hospital leaders may frequently feel that their backs are against a wall as they face pressure from payers, competitors, legislators, and others. Their challenge is to think creatively to find strategic paths that are designed not to reluctantly defend territory, but to take a positive step forward.


Publication Date: Wednesday, December 01, 2010

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