Thursday, September 28, 2006


This story from the Hamilton Spectator kind of hits home for me. It talks about a small hospital and what hospital administration does to try to improve the hospital and the community.
Why wouldn't Hamilton Health Sciences (HHS) put more money into emergency rooms to attract and keep doctors? Why wouldn't HHS top up emergency physicians' salaries to ensure stability and appropriate levels of service? It makes good sense.
Especially for small hospitals and small communities like this one and like mine, there are limited resources and priorities have to be made on where and how resources are managed. I'm all for getting the best docs and building the best facilities, but there are consequences to that.
The problem with emergency staffing seems to be double-edged -- crummy working conditions and pay that's not great. HHS has chosen to address those issues to ensure adequate emergency services.
Don't get me wrong. I'm not trying to lead you down a path here - especially with my posting yesterday of paying docs more. Like I said above, my small community and my small hospital are going through this right now.

On the one hand, having the best and most modern facilities can attract docs and other medical professionals to our small town and hospital. Who doesn't want to work with the latest and most technological toys?

On the other hand, something has to give. Sometimes that means pay freezes and/or pay cuts to the rest of the staff whether it be nursing, respiratory, secretaries, custodians, etc. Or, short staff situations. This can have effects on patient care and hospital morale, and other areas. I don't have the perfect solution. I'm curious what you think.

Question: If you were CEO of a small hospital with very limited resources, how would you help insure the best medical care for your community?


Julie, RN said...

For starters, I'd consider minimizing administration; number of those in charge and salaries involved. Then, I'd question whether the public really benefits from landscaping, room service, and valet parking. Monies saved from aforementioned cost-cutting could be passed on to vital staffing issues, and spread a little more thinly on our quest for magnet status (which won't matter anyway if we can't afford to pay for the best... etc.)

Anonymous said...

First, I agree with Julie. Second, I would get involved with some fundraising events (ie auctions, etc). It may seem like a bandaid, but people's generosity is amazing at times, especially when folks can see the benefits of their donations.

The Curmudgeon said...

How? I agree with what julie, rn said -- let me add to it.

You said "having the best and most modern facilities can attract docs and other medical professionals to our small town and hospital."

I think that would not work -- cost prohibitive -- so to get and keep qualified staff I'd have to sell the amenities and benefits of small town living. If I can't get the latest gadgets maybe I can get living quarters in which to house my young or empty nester staff for nothing, or next to? (Makes up for smaller salaries....)

What else can I sell in your hypothetical small town? Hunting? Fishing? Squash? (I thought Doc Hollywood was a pretty good movie.)

I'd think you'd have to focus on what the town needs; the small town hospital can not hope to be all things to all people. You'd need to focus on people who can deliver babies, decent ER care (even if it is only stabilize and ship out decent), therapy facilities, and a working relationship with a big city teaching hospital for the specialized or rare cases.... which could be the source of new staff because you'd have to expect frequent turnover.

rdl said...

I think getting rid of the HMO's might help. I used to me for them when they offered affordable serices, but now I basically work for the privlige of paying an unbelievable amount of $$$ for my insurance benefit with a very high deductible so that all it is really is high priced hospitalization, like our folks used to have with alot more bureucracy and money.

INAMINI said...

I agree with Julie. I'm not at all involved in the health-care field, so my idea may be way off. How about investing some of the money in the new technology that can facilitate diagnoses/surgeries by specialists by computer? That way the patients would have access to the best doctors from all over.

Empress Bee (of the high sea) said...

in Podunk there is a wonderful small hospital but I have absolutley no idea how it works. i do know they have all the latest and bestest stuff though. and all the employees seem happy. if you want i could email you their name and you could check with them. good luck......bee

ipanema said...

Question: If you were CEO of a small hospital with very limited resources, how would you help insure the best medical care for your community?

I would explain it this way:

Keep the best personnel->efficiency->happy patients->donations or new patients may come->invest on latest technology, so they won't go to hi-tech hospitals->more patients->save->raise salary of personnel->more efficient->more happy patients->good reputation->more income->build a bigger hospital fully equipped with latest med gadgets.

Everyone will be happy. I hope so. :)

It's me, T.J. said...

The first thing I would do would be to look at the accounts receivables. Is it too high of a ratio? If it is, what seems to be the problem? Poor collections? If this is a problem area, I would start working on it now and approach it with a very strong plan.

The next thing I would do would be to look at efficiency. Are the current staff efficient? I'm talking about from maintenance to administration. Does the staff have any performance incentives? Making your staff more efficient means that you need to hire fewer employees.

While I was looking at staff efficiency, I would also look at the efficiency of the procedures within the hospital. All the way from maintenance to adminstration. Are there duties that are being duplicated by other staff? Are there antiquated modes of doing business within the institution? There's a lot to be said for the adage, "Time is money."

If I were to invest in new technology and equipment, the first thing that I would invest in would be items that would make the hospital more efficient. The cost savings in time, salaries, and waste could be substantial and would then add to the budget for medical amenities.

I would also look into digital radiography. The cost savings in film, chemicals, disposal, maintenance, storage of films, etc., would be substantial for a hospital of any size.

I would then look at scheduling. While it would be good to "sell your community" to personnel prospects I would also think that scheduling could be a selling point. Offer 'flex scheduling' to the all the staff. Some people may love the idea of working three days and having four days off during a week.

Also involved in scheduling is duplication. Are there areas of the hospital that are being duplicated by too many staff? Scheduling can be approached much in the same way as how a call center approaches it. You schedule heavy for the busiest times, and lighter for the not so busy times. Even though it is a hospital, all businesses have "patterns". ie: Do we really need x number of people on Mondays from 1am to 5am? Do you have a computer program than can 'break down numbers' for things like how many people checked in the ER during a certain period of time? This would be a software package that I would invest in.

Then there are the deliverables. What services does your hospital have that it can "sell" to the public? A birthing center, annual mammograms, heart scans, senior wellness programs, baby wellness programs, etc. These areas could become profit centers for the hospital and should be marketed as such.

If one were to consider buying new equipment I would first look at the items that would create a profit center. Be competitive and sell yourself to prospective referring doctors.

Do you have an MRI? How far away is the next closest one? People live for convenience that has quality. Advertise what you have and sell yourself.

Finally, I would look at quality control. If you aren't doing a good job, you aren't going to get any repeat business or referrals.

Sorry to be so long.

I got carried away.