Beating Up the Crew So the Ship Will Go Faster

August 3, 2020

Holding providers and staff accountable for the administration's decisions leads to negative impacts.

A hospital in my neck of the woods sustained a self-inflicted financial wound. Its chosen remedy leaves something to be desired.

Readers are probably aware that the U.S. government has offered some lifelines to citizens and businesses in the past few months of COVID-19. Healthcare entities, understandably, have gotten an extra helping hand.

This hospital decided that it would be a good idea to use the assistance to build a new wing. And now, with cost over-runs (and probably the actual COVID-19 costs that the assistance was supposed to help offset), the facility finds itself swimming in red ink. To the tune of dozens of millions of dollars.

The rank-and-file of this hospital are now finding out about this situation because the leadership, in an effort to recoup this deficit, is embarking on a campaign to size up the productivity of all employees who generate revenue for the facility. How much, doctor, is being billed in your name? Nurse/PA, could you be earning more for the hospital than you have been?

All of which comes with a doesn’t-need-to-be-spoken threat: Pick up the pace, or risk punishment (loss of compensation, addition of new responsibilities without commensurate reward, or even termination). Meanwhile, the hospital’s non-producing personnel, who don’t have easily-surveyed billings (including the administrative types who got the place into this mess), are conveniently left out of the accounting—and exempt from its repercussions.

Rather a tidy illustration of something I’ve bemoaned in columns of yesteryear: The lopsided situation of a healthcare system with two major classes of denizen. Those who actually produce/deliver healthcare, and those who don’t, but presumably provide “support” to those who do.

This wouldn’t necessarily be a bad thing, but all too often, that “support” turns into varying shades of “guidance” and “leadership.” Another word: Control. We wind up with people who don’t provide healthcare, maybe never did, riding herd on those who do. One wonders how much this upper tier can ever really understand things from the healthcare-providers’ perspective. Or, for that matter, care about it.

It’s not a situation unique to the healthcare world: Businesses all over the place have employees with highly-advanced skills that the CEOs and other muckety-mucks do not. That’s the reason for delegation and sub-specialization.

Still, in an organization like a hospital, where you have some people that make the place function (sort of like the crew of a ship), and others who don’t—consider them officers or simply passengers—it doesn’t make a whole lot of sense to beat up on the crew when the commanders have made an unfortunate, even stupid decision. True, maybe the crew is your only way out of the mess you’ve created...but how much more are you likely to get out of them by threatening to cut their rations or lengthen their hours? Or even throw some overboard?

Is it likely that their motivation will swell to new heights, and they’ll make the ship go faster? Or will their morale drop—resulting in a reduction in productivity, and maybe new eagerness to find another ship that will treat them better? Maybe build their own?

At least, in the case of an old-timey ship, the officers had some level of accountability to their crew: Treat them poorly enough, make enough bad decisions, and you might have a mutiny on your hands. We don’t really have that in the case of a hospital: Most physicians aren’t allowed to unionize, and even if they did get organized, striking or intentionally slowing down their work would punish patients far more than hospital leadership…not a conscionable option for most docs.

I’m sure the leaders of this particular hospital would claim to have all sorts of good intentions for doing what they did, both in terms of mismanaging, well, allocating their COVID-relief funds and the subsequent attempt at damage-control. Perhaps they’re confident that they have justified themselves to their trustees and need not look good in anyone else’s eyes. Still, when I heard about their mess, it occurred to me that there had to be better ways to fix it:

  • Back out of, or at least delay, the new-wing expansion. Sure, some of the cost might not be recovered, and the hospital leadership won’t immediately get a shiny new bit of construction to glorify themselves. Still, it takes a pretty immense ego to think the wisdom of “If you find yourself in a hole, stop digging” does not apply to you.
  • Share the reward. If you’re going to plow ahead with your costly plans, built on the backs of the healthcare providers whose billings make your hospital viable, at least let them have a piece of the action in this new wing. Let them “opt in” with an incentive: Improve your productivity, and get a small slice of the revenue generated by the new wing. (Automatically include folks who were top producers before all of this, as long as they keep it up.)
  • Share the pain. Again, if you’re bound and determined to maintain your present course, for pity’s sake don’t just target the people whose productivity makes your facility run in the first place! They’re the ones who are holding the roof up over your head. Include everyone in your belt-tightening plan…especially the leadership. Heck, make a big show of it: “Everyone, I might have made a strategic mistake. While I’m confident that things will turn out well in the long term, in the meantime I will be giving up 10 percent of my compensation-package while the average hospital-employee gives up 1 percent to see us through. And, if that turns out not to be enough, I will increase my own sacrifice before anybody else loses another dime.”