When hospital CEOs issue clinical directives, healthcare suffers

[Originally published by Hospital Impact]

“If there is a surgical intervention option as well as another treatment option available, make sure you go the surgical route.”

“Are you serious, Jim?” I responded. “The CEO of your hospital said this to your new podiatric surgeon?”

“Yes. We had recently brought on this podiatric surgeon and the hospital CEO made it very clear to him early on that the expectation is increased numbers of surgeries and if, in fact, there are multiple treatment options the surgical option overrides all others.”

“So a hospital administrator is now making specific healthcare decisions for the patients, families and clinicians at your hospital?”

“That’s exactly right. It is shameful, it is harmful and it is wrong. And yet it is happening.”

This is an excerpt from a recent discussion I had with a former rural hospital medical director and current quality improvement expert. And, unfortunately, even though I want to say I am surprised, I am not, as I have heard similar type stories quite frequently. Such as the hospital CEO (who is also a physician) telling me directly that quality of care was not his highest priority because he was focusing on the financial health of his institution.

And as Jim said, this is “shameful, harmful,” (and I would add expensive) “and wrong.” And it is wrong on so many levels…

  • We talk often about patient-centered care. This is the exact opposite. This is hospital-centric care. And it is so with the specific intent of generating additional revenue for the institution.
  • We talk about patient education. It doesn’t seem to me that this CEO directive would allow room for optimal patient education in which the patient would be fully aware of all the options available (and their risks) prior to a treatment decision being made.
  • We all (or many of us) say we want to ensure we develop partnerships with patients, yet in a true partnership there would be an authentic relationship, transparency, trust, and optimal communication and sharing.
  • There is much discussion about shared decision-making, and yet in this scenario clearly the decision has already been made and the focus has turned to the implementation of the decision, the surgery.
  • Reducing per capita costs is reportedly a priority in the healthcare system, and yet this directive, in many cases, will increase costs (if, in fact, a lower cost with less risk option is available and appropriate).
  • Patient engagement? Maybe surface engagement as the decision is implemented. But an authentic relationship, transparency, with trust and optimal communication for informed decision making? Not quite.
  • Patient experience is another purported high priority within the healthcare system, and while it is possible that patients will have a positive experience in this scenario, but if they were fully aware that other options may have been available to them and also aware of the risk they faced without fully understanding the other options, I would surmise their experience score would decrease significantly.

“A podiatric surgeon is trained to assess the patient as a whole and provide a range of non-surgical, medical and surgical interventions,” according to the College of Podiatry. “The clinical performance of the podiatric surgeon should be guided by professional standards against which the podiatric surgeon may be judged.”

And absolutely a surgical intervention may in fact be the best option for a patient.

But a healthcare administrator must NEVER take this decision making into his or her own hands. As non-clinical healthcare leaders our jobs are to ensure patients, families and clinicians are best positioned for shared decision-making; that they have access to the best information available in which to make decisions (and optimal understanding of this information); and have the space and tools to co-create care pathways that are appropriate and aligned with the patients’ preferences.

When we do this together we will measurably improve patient safety, patient experience and patient outcomes. We will also reduce the cost of care and in doing so will be better positioned to re-invest these savings in additional areas to positively impact our patients, families and communities.

Anything less is unacceptable.

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