Please view my guest post Before Alignment, published today at HospitalImpact.org.  HospitalImpact is the brainchild of Tony Chen, who started it to focus on change as an exciting opportunity rather than as something that is done to us.  I will post once a month on topics that allow hospital leaders to get inside the head of physicians and depersonalize differences that are based on outlook, background, and training.

In doing so, I expect to be the lightning rod for comments like those of Dantes, who wrote:

Sorry…physicians are being marginalized using deliberate tactics of hospitals and the hospital bar…. Look at the attacks hospitals make on physician who stand up for good patient care. How about hospitals impeding new care delivery systems, such as specialty hospitals. Hospitals plead poverty, but especially in the case of not for profit systems, have billions in reserves. They run up huge profits, pay ever more extravagant salaries,and try to get control over physicians by hiring, contracts, and overt and covert threats….Meanwhile the AMA stands mute. AAPS is trying to fight the fight. Corporate medical care is upon us, and for all your talk about interdependence, etc, hospital administrators are an impediment to good care.

To Dantes, I write, thanks for making the time to comment.  We clearly have different experiences.  Hospitals where I choose to work do not try to control physicians by hiring, contracts, and threats.  As I wrote in Collaborative Control, I watched a CEO stand up to his Board chair, who asked the CEO, “Are you worried about ceding control to the physicians?”
The CEO calmly replied, “Heck no, I never had control in the first place.”

Where I choose to work, hospitals that employ physicians do so because, either reimbursement has fallen to the point where physicians cannot pay expenses and still make a living, or because physicians want more balance in their lives and the security of salary and benefits in a rapidly changing economic marketplace.  I feel passionately about the value of interdependence because I have seen the benefits of improved clinical and financial outcomes resulting from professionals actively listening to each another and treating each other with mutual respect, as I wrote in Collaborative Indifference.  I cited:

• an ICU Director who collaborated with middle managers to improve processes that decreased the mortality rate from sepsis from 46% to 23% within one year without any change in medication
• a medical advisory panel that collaborated to save over $500,000 in supply costs related to orthopedic implants,  heart valves, and medications
• a hospital that hired a fellowship-trained laparoscopic surgeon as a part-time surgical intensivist, so that he could train the other general surgeons in advanced laparoscopic surgery, which decreased outmigration, boosted revenue for physicians and the hospital, and allowed patients and families to receive care within the community rather than having to travel an hour to the nearest tertiary care hospital

 I do not mean to start a blog war, but I do want to know what you think.

• How would you reply to Dantes’ concerns
• Do increasing interdependence and decreasing physician autonomy compromise care
• Do you see an alternative to fighting to move from “us vs. them” to “we”

As always, I welcome your input to improve healthcare collaboration.

Kenneth H. Cohn