Theory #3: nextHospitals can make changes quickly

According to some researchers, hospitals are among the most hierarchical, rigid organizations in existence, just a notch below the military.  And if so, it’s not much of a surprise.

After all, in one way–and I know clinicians hate to think about what they do this way–hospitals are factories which attempt to produce extremely consistent results.  It’s no surprise that models borrowed from manufacturing, like the Toyota Production System, can be very valuable for hospital execs. And of course, it’s no surprise that hospitals are hierarchical, since they, like the military, must react quickly to life-and-death situations.

That being said, hospitals lack one of the military’s great strengths, the capacity to deploy their forces quickly and change direction on command.  While armies are set up to make swift strategic changes,  hospitals are far more static. Too often, it takes a whack on the head from the Joint Commission or a major financial loss to get them moving in a new direction.

nextHospital executives will have to drop the 50s-era management philosophies, root them out from their subconscious if necessary, and become more fluid and their forces deployable as community needs change.

The hospital industry’s’ response to the H1N1 virus is a perfect illustration of what’s possible.  With a many-tentacled threat looming, hospital leaders are moving quickly to deploy off-site screening centers, develop new triage procedures to sort the sick from the worried well, change their visitation policies and more.  In some cases it’s not clear which approaches make sense, since we don’t have a pandemic lashing the U.S. every week, but execs aren’t waiting for an engraved invitation.

What’s interesting is that hospitals have attacked the H1N1 pandemic with such vigor rather than showing such alacrity wish, say, infection-control efforts. Yes, I know many readers are working very hard on this issue, and moving cautiously is certainly smart, but let’s face it, industry-wide things aren’t changing quickly enough.  My feeling is that the difference is rooted in human nature;  for most of us, it’s far easier to respond to a short-term crisis than change the way we work every day.

But nextHospitals–the hospitals that respond to a world powered by high-tech, global travel and rapid cultural shifts– will not have the luxury of separating critical problems into those we can address and those we can ignore. And hospital leaders will need to build flexible, even fluid, organizations capable of making that leap.

How can we make this happen, readers?

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

1 Comment

  • This is so going to give the critics something to shoot at, I suspect. The mixed hospital-military analogy, although interesting, results in only a scratch to the surface of core issues that need to be addressed for nextHospitals to possess the flexibility you desire.

    For the sake of transparency, I am not a hospital administrator; however, I have consulted for a few on issues related to H1N1 issues.

    First, hospital administrators face two significant limitations the military does not: operational scalability, loose constraints on capital, and an ability to shape external events as part of a total solution. That is, where a military commander can move personnel and material, the hospital administrator must necessarily work from a fixed operational base
    Hospitals are not built for flexible use of space, operations are intentionally static for quality control and patient safety, and administrators are truly compensated for managing them within rigid expectations for resource use and financial management.

    The author uses a surge event as her example, so I’ll follow it. For these purposes, recognize that a surge event can be either dynamic and immediate, such as the H1N1 outbreak, or gradual, such as population growth in a community served by a hospital growing beyond the hospital’s space capacity to support. In either case, resource allocation becomes the fundamental issue. Are patients directed to other locations, a daily problem in much of America; are alternate facilities set up; or are existing resources directed away from one area to address the surge requirements? Will additional staff be called on to meet the surge? What’s the financial impact on a community hospitals whose resources are already strained by diminished tax revenues and budget cuts? What will it cost to take over a local hotel in order to provide more isolation space for patients, and what security and patient care issues does that raise? This problem could be further exacerbated if all primary care is provided at the nextHospital, as suggested in an earlier post.

    That said, it seems the real question is how are nextHospitals constituted so the limits that restrict management flexibility can be effectively removed when circumstances demand it.

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