There are times when I have to pull off my writer's cap, and my military wife hat and become once again, The Surgeon's Wife. I do this because for almost all of my life, I have been The Surgeon's Wife. I helped run his clinic, counseled his patients, took care of our employees, paid the bills, set office policy, and got into arguments with hospital administrators and insurance big wigs when it was needed. There were things I disliked, but overall I enjoyed it and learned a lot.
I've been reading and watching this Army system going on 2 years now. I've visited them, received emails, and have perused the forums. I think there's a lot they do right, but there are things that makes change difficult. The Army moves medical personnel around every three or four years. Toss in a deployment, and now their term at a hospital is reduced considerably, especially if they're going over every 18 months. The doctors become little more than transients, as do the administrators. The net result is a relationship between the permanent federal employees and transient military staff where real institutional change is almost impossible due to lack of consistency.
What happens is this:
nothing changes. One doctor was even told by a federal employee, upon asking for changes, "I'll outlast you." While is was utterly disrespectful, it was also true. The doctor will move on, while the hospital and the federal employee will continue on like a hamster in a cage with a wheel.
All of this runs counter to how private hospitals are generally run. Mind you, much is changing because of the corporately socialized healthcare that has led to profits before patients, and huge executive salaries and compensation. But, nevertheless, there are lessons here to be learned.
What the military hospitals need are constancy and consistency in
leadership. Someone sent in for four years is facing the fact that the federal employees have already won. They know it's only until the next guy comes through, and besides, firing the delinquent employee is a process that would tire Job. So often the new leader tinkers with the mission statement. While one can play with vision and focus, it's futile unless one is willing
to challenge the institutional work ethic.For instance, if one finds a scheduler never schedules patients after 4 PM; if the clinical and OR staffs are allowed to clear out by 3 PM; if people are putting more energy into whining about their plight than working at their station; if a Friday afternoon clinic isn't full with patients who don't want to put things off for the weekend; if there are no support groups or wellness workshops slated for the evenings or weekends then the phrase
work ethic needs to be defined.
So I'm trying to figure out what would happen if military personnel were posted to a hospital position for a more than 4 years with results to be reviewed quarterly. If someone doesn't measure up, then thank you very much, go have fun in the civilian world. I tell you this, civilian medicine is really tough.
While 6-8 years
seems like a long time, in a really good civilian hospital a CEO often leads for
ten but more likely
twelve. Administrative staff stays even longer. In short, they do so because it's a
community. It's tied to every person in the region: the moms and pops, the kids, the business owners and the schools. One could say a hospital's role in a community is as important as the city council, the fire department, and the city staff. In other words, their presence counts not just to the people working there or getting treated, but to everyone who comes into contact --even if on the periphery. There is no reason military hospitals cannot be the same.
Perhaps the career path for military health care personnel needs to be much different. Rather than jumping from post to post, the emphasis needs to be on providing a constant leadership that leads to consistent levels and excellent patient care.
Lastly, it needs to be repeated that doctors are best and
happiest when doctoring, not administering. There's a reason they spent 4 years in med school and another 5 years in residency, plus another 2 in a fellowship. There's also a reason we have administrators. The two work best at running hospitals
together, but it does not mean that there won't be a bit of tug-of-war.
A few years ago, we worked with a CEO at a major regional hospital here in Los Angeles. Everyone had a story to tell about this man. Many had even wrangled with him. He was not an easy person to work with, yet, everyone respected that he was the final word. When he retired, they named a street in front of the hospital renamed, "Dan Adams Way." The truth is, Dan had provided a vision for the hospital and also consistent leadership for over a decade. During his tenure, it had become a leading cancer treatment center, a hospital renown for both its clinical and surgical excellence. Because he was there a long time, he knew what battles to pick with insurers, and any other number of entities in order to be a positive presence in the community and produces results.
There's no reason why AMEDD and Navy Medicine can't do the same. Later I'll get into the ridiculousness of having two separate entities.
If you want to see more of my writing about the state of healthcare in general, go to my old blog, Easy-Writer. In the search box, type in "healthcare."
Posts
