What goes around comes around

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In October, USA Today printed a series on health care costs and quality as a follow-up to a survey that found that many Americans are worried about rising health care costs and are dissatisfied with the quality of care. That shouldn't surprise anyone; the surprise for me is that it has taken the average American that long to see the handwriting. Signs of a demoralized health care system started in the mid-1980s, and it has continued to escalate over the years. To their credit, USA Today collaborated with ABC News and the Kaiser Family Foundation to look at positive solutions from the health care community, rather than focusing on the negatives.

What struck me most was the article appearing in the October 20, 2006, edition, with a headline of “Hallmark of Quality Care: Efficiency.” The article discusses streamlined processes and the improvement in quality care and costs in two hospitals; one in the East and one in the South. Streamlined, effective teamwork is described as a major contributor to their successes. One section states, “Providing better care isn't just good for patients. It can also be good for the bottom line.” What a surprise!

I related so closely to it because, in 1986, I wrote and edited a book entitled Nursing Productivity: The Hospital's Key to Survival and Success, published by Springhouse (it is now out of print). The book stressed the importance of recognizing that “quality and productivity (aka efficiency) are two sides of the same coin,” to quote Lee Iacocca. I had the good fortune of sharing that philosophy and the work we did at Cedars-Sinai with a large audience of nurse leaders through seminars, lectures, and articles. That principle has driven all of my work throughout the years and was the hallmark of my strategy as CEO. It continues to be the driving force in my consultations and writings.

Magnet status, for example, is great because it not only provides an excellent system for the delivery of patient care but, done well, it is good business. One only has to look at the reductions in errors and the cost savings associated with this to validate the philosophy of Magnet status. Adding to the costs associated with recruitment and retention at approximately $40,000 per nurse can be an eye opener for many organizations, including the costs of unplanned registry staff when many openings seem to exist more in non-Magnet than Magnet hospitals. The challenge, of course, is not to just maintain that status but continue to work to improve on it. Nothing remains static.

The disappointing part of this particular article was its failure to mention the critical role of nursing in producing the desired outcomes. My experience is that nursing often drives the improvements, at least at the executive and management levels. Too often the staff “doesn't get it,” and their resistance to doing things differently requires a frontline nursing manager who is skilled and educated at process improvement, change management, and team building with and among her staff and interdepartmentally. The importance of gaining these skills cannot be understated. Providing educational opportunities to achieve the desired outcomes must be the goal of the organization and the chief nursing executive, in particular.

Another key ingredient to success is measuring the outcomes. We have become quite skilled at clinical outcome data, but to my dismay, productivity (efficiency) data are still lacking in many places at the frontline management level. People do respond to measurements that are timely, reliable, and valid. The book on productivity written in the 1980s introduced and discussed the value of management reports that allowed for easy interpretation on a timely basis that could both reward individuals and help them initiate positive changes. It is also a key method to validate staff skill mix, correlating the clinical data with the financial management data. Several companies and consultants have successfully introduced these formats, but they are still not adequately applied in the industry to demonstrate the strong relationship between positive clinical outcomes and financial success.

With all that said, I congratulate those health care organizations that have taken a giant leap forward in modernizing processes, focusing on outcomes, and building interdepartmental teams and relationships to break down silos. Their success reminds everyone that they are there to ensure excellent patient care, which can be provided only if the institution is also financially viable.