I recommend to you Michael Rindler’s recent book, Strategic Cost Reduction: Leading Your Hospital to Success. He shows how hospitals can achieve a 5% or greater annual cost reduction without compromising quality, safety, or service.

I particularly enjoyed case presentations that showcased the strategies in clinical practice:

• A community  hospital demonstrated that hiring additional housekeeping and nursing staff for the Operating Room from 3-9 pm weekdays eliminated overtime costs and diminished turnaround times; I bet that surgeon morale also improved dramatically as a result of this counterintuitive invest-for-success strategy;
• Another community hospital, faced with patients boarding in the Emergency Department for 24 hours awaiting ICU beds, formed a multidisciplinary task force that identified physician-physician communication problems and delays in obtaining diagnostic tests as the principal bottlenecks; once new expectations and communication protocols were implemented, holding time in the ED decreased to 3 hours or less, and the task force disbanded, welcome news to any physician who regards a committee assignment as a lifetime sentence.

Mr. Rindler pointed out that consistency enables hospitals to anticipate patient needs and decrease expensive complications, as discussed in Collaborative Independence, where cardiac surgeons went over a year without patients experiencing postoperative mediastinitis once they all agreed that any PACU or ICU patient with a blood sugar over 110 mg/dl would be placed on an insulin drip to maintain blood sugar between 80-110 mg/dl. Previously, the annual incidence of mediastinitis had been 1.2%.

Sustainability of the strategic cost reductions Mr. Rindler espouses requires building a culture based on transparency, accountability, and trust.  A winning leadership culture also cherishes teaching and training at all levels.

What do you think?

• Does the current budgeting process encourage hoarding rather than sharing
• How do we improve inter- and intradepartmental collaboration and view strategic cost reduction as a shared vision for the future
• What examples from your organization support Mr. Rindler’s assessment, based on three decades of experience, that every hospital has the ability to reduce costs at least 5% annually without compromising patient care

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

Kenneth H. Cohn