“Dad, what hospitals are good?”
Working for the Pennsylvania Medical Society, traveling to many hospitals, and speaking to physicians across the state, I was flummoxed when my son, a surgeon to be, asked me that question.
There are so many ways to measure good. My readers know that one of my favorite phrases is “the devil is in the details.” Multiple websites, publications, and experts will tell you (in their opinion and based on their criteria) what the best hospitals are. They aren’t always the cleanest, they aren’t always the most expensive, they are certainly not always the biggest, or the universities, or whatever.
Good for whom? My parents always go to a local hospital because “the parking is easy, and the nurses are nice.” I worked there, and it would not be my first choice because underneath the niceness are procedure, process and culture issues that interfered with optimal care over and over again, in my humble opinion.
My son would want a hospital that had good process, procedures, and culture. Sometimes these are reflected in outcomes, but sometimes it is the outcomes that aren’t measured for public reporting that reveal the whole truth. Giving something a fresh coat of paint can successfully hide a rotting infrastructure that is waiting for the wrong stress to break it down. He would want to know that nothing is being buried in a back room, under a tarp, that maybe the public should know about.
What can we measure? I have always said I would rather hire someone eager to work and learn than someone who knows the job and has all the knowledge needed but no enthusiasm and interest in doing it well.
Let’s narrow it down a bit further. The literature and a recent white paper published by ACPE seem to indicate that physician leadership and engagement are important. No, the CEO doesn’t have to be a physician, but the CEO has to truly believe that working with good physician leaders will lead to success. In addition, that CEO has to create an environment, a set of rules, and governance that prove physician engagement and involvement are important. Finally, and perhaps more importantly, the CEO has to create and enforce a culture that does the same.
You can’t improve what you can’t measure. How do we measure good governance? How do we measure good culture? What are the barriers to improvement? Is there enthusiasm to learn and to change for the better?