By JN Hahn
Unfortunately, I’ve become quite familiar with hospitals, six overnight stays in three years.
All of these, with one exception, were at Yale New Haven Hospital in New Haven, CT.
These admissions were serious, one a 911 call, but all mitigated by the time I was discharged.
This essay isn’t about my health, it’s about an industry called Healthcare and its delivery system, called Hospital.
My hospital visits qualify me as a peripheral expert, I’m not a healthcare professional, I’m a patient, i.e., a customer, who can evaluate outcomes and how they were achieved. My conclusions are based upon firsthand observations of efficiency, administration and management cornerstones of a successful enterprise.
Hospitals are big business; they service thousands of patients annually doing their best to deliver an effective product. A product that can often make the difference between life and death. They do this while simultaneously managing budgets, logistics, supply chains, human resources, community outreach, government regulations and a myriad of details hidden from patients but critical to their care.
Like any business, the buck stops at the top, it’s all about leadership, the CEO sets the tone and drives the enterprise towards successful outcomes, and in this case it’s patient recovery.
Like any successful enterprise in a capitalistic society, capital and positive cash flow are essential. Hospitals are nonprofit and tax free but unlike other businesses they can’t trim costs at the expense of patient care. A classic conundrum. That said, they can run their business efficiently with good staff recruiting, training, and technology in support of their medical doctors and registered nurses.
Hospitals are rated; the best develop a global reputation, a brand, that stands for exceptional results in specific specialties. These hospitals attract funding, community support and graduates from top medical schools: Harvard, Johns Hopkins, Cornell, UPenn, NYU, Stanford et al.
Hospitals like the Mayo Clinic, Cleveland Clinic, Johns Hopkins, New York-Presbyterian, Mass General and others are the best because their leadership is the best. Hospital boards should demand top executive talent if they expect the best in patient care.
The Mayo Clinic is consistently rated the single best hospital in the United States in 12 specialties, the Cleveland Clinic is best for cardiology and so on. These “brands” got where they are with consistent results, results driven by leadership.
I live close to Yale University, the medical team that supports me and my wife’s health, are all affiliated with the Yale Hospital and/or medical school. Yale is not ranked in the top ten, but they are ranked in the top fifty in a market of 6000 hospitals countrywide. They’re a large research facility specializing in cancer, cardiology, neurology, urology and COVID-19 to name a few.
I’ve been in that hospital five times in the last three years, not a record I’m proud of but one with consistently happy outcomes.
When you’re admitted to a large metropolitan hospital, the hours and days you spend in bed begs the question, “how do they manage this enterprise?”
The supply chain alone for disposable gowns, gloves, needles, bandages, sponges, laundry etc. seems overwhelming. How do they control quality, cost, delivery and the myriad of details inherent in a for-profit value chain while at the same time managing a life or death product? How do they manage their HR program with over 26,000 employees? Which functions are outsourced to contract providers and how are those relationships structured and managed?
We only know a hospital, or any enterprise, by the product they produce whether a car, an appliance or healthcare. If I went in sick did I come out well? If we didn’t, we would look for a new provider. Like switching from Chevy to Ford because of multiple recalls, in the case of hospitals there are no recalls for faulty brakes or safety belts, if their products fail it can mean your life.
The patient survey emailed to me after discharge validates my thesis, a hospital is a provider, an enabler if you will, of healthcare services. Management wants to know what you thought of their product and how they might improve. I always complete those surveys in an objective manner, acknowledging exceptional performance and isolating areas needing improvement.
Senior management for a hospital is an essential job, like a nurse or a surgeon, you depend on them for professional expertise.
I’m fortunate to have Yale in my backyard, as big as they are, their service is local, with state-of-the-art facilities and highly trained Doctors and Nurses.
Hopefully I won’t be a repeat customer anytime soon.