• Foreword: This Is Not a Drill

    Nov 01, 2011

    The case studies in this issue celebrate the rewards of planning and persistent follow-through

    There's an old morality puzzle: An art museum is on fire, and the firemen can make only one trip into the blazing building. They must choose what to save: a few of the museum's most valued paintings or a stranded elderly woman.

    Of course, the firemen should save the woman. Yet, many people, while commending the firemen's decision, would also grieve the loss of the art. Anyone who has ever been moved by a Van Gogh or a Warhol understands the intrinsic value that art evokes-not only to individuals but to the community as a whole. 

    This is the foreword to the Fall 2011 Leadership report, Managing Business and Clinical Risks.

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    Wasn't there some way to save the woman and the art? If museum directors had planned ahead and instituted precautions, could the fire have been prevented or at least contained?

    On the surface, a healthcare organization and a museum have little in common. Yet each has obligations to individual patients/patrons and to the community at large. If a hospital or physician practice burns down-or folds for financial reasons-the community would lose a valued asset: a source of jobs, community education, and local pride.

    As we all know, the healthcare industry is in the midst of cataclysmic change: cuts to Medicare and Medicaid, the transition to value-based payment, record-breaking mergers and acquisitions, and on and on.

    In other words, fireballs are flying from every direction.

    One reaction is to cite the futility of planning because so much is in flux. This issue of Leadership is about the reverse philosophy: To manage a raging fire, you need to erect the necessary safeguards while also investing in a future vision, forming needed partnerships, empowering staff, and tracking performance.

    A commitment to value-improving quality and reducing costs-is a common risk strategy among the providers in this issue. For example, rural health system Winona Health has merged with local physicians and redesigned its service lines-reducing its 30-day readmission rate to just 2.2 percent, compared to the 18 percent national average (page 16).

    Another example: Sentara Williamsburg Medical Center has not had a single ventilator-associated pneumonia incident in more than seven years (page 22) On the outpatient side: Consultants in Medical Oncology and Hematology (CMOH) has helped its patients avoid more than $6.5 million in hospital and emergency department charges in 2010 by proactively managing common symptoms related to cancer treatments and underlying diseases and conditions (page 24).

    The case studies in this issue celebrate the rewards of planning and persistent follow-through.

    "We're bending the healthcare cost curve by eliminating unnecessary expenditures," says CMOH's John Sprandio, MD. "This is better care for our patients, and less expensive care."

    The lesson: It is possible in these risky times to keep patients safe while also securing your organization's future (in the same or some altered form). But not without a well-executed plan.

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