A physician chimes in: “If you’re the only hospitalist there, they don’t have a choice.”
Dr. Guthrie, quick to seize upon what he sees as a teaching moment, tells the group to “be careful.”
“In the short term, that’s absolutely true,” he says. “In the long term, there are a lot of other alternatives. And if there aren’t, someone will invent one. You see that’s the thing about our society—if there’s an opportunity with a whole, big, dissatisfied customer segment, somebody will notice and invent the way to satisfy their needs. That’s called capitalism.”
It’s what happened with the late Steve Jobs and the iPod, when he realized customers needed a way to easily access their music collections, Dr. Guthrie points out.
“He understood the dissatisfactions of the market,” he continues. “Before that, they didn’t have any choices.
“Healthcare is the same. But it’s a little more difficult to develop those choices. It’s hard to build a new hospital right in the middle of someplace where there’s only one hospital. So they invent other ways to do it, ways to get their patients taken care of: They travel.”
About 700,000 people flew to Southeast Asia last year for medical procedures, he says, making the point that American patients have options.
“Somewhat difficult, but they do have alternatives,” he says. “Customers will, when pushed hard enough, if dissatisfied enough, leave you, even when you think you have them trapped.”
Dr. Michael Guthrie, MD, MBA
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Source: Hartman, M: Martin, A; McDonnell, P et al. (2009). National Helath Spending In 2007: Slower Drug Spending Contributes To Lowest Rate Of Overall Growth Since 1998. Health Affairs, Jan/Feb., p 247. www.healthaffairs.org). See also, Orzag, Peter; Congressional Budget Office (2008). Growth in Health Care Costs, testimony before the Sentae Budget Committee, Jan. 31, p.1. (www.cbo.gov/doc.cfm?index-8948). Center for Medicare & Medicaid Services, January 2011.
Think Tanks
A key part of the session is time set aside for group work, in which Dr. Guthrie gives the class an assignment and attendees tackle it at their tables as a unit. The first task is to identify business drivers at hospitals, what the objectives of the hospital should be in response to those things, and how those objectives affect the work of hospitalists.
Then the groups go to work. A few minutes later, though, Dr. Guthrie speaks up through the chatter.
“Let’s stop for a minute. I want to tell you that most of you are on completely the wrong track,” he says, drawing chuckles. “But this is part of the reason we do it this way. The idea here is to get outside of your head.”
One group lists “profit” as a business driver.
“Profit is not a business driver,” he says. “I know you’re sort of raised to think that way. It isn’t. It’s a measurement. It’s like blood pressure. So it is not a business driver. We use it as a measurement of the success with which we’re synthesizing the business drivers and the environment and meeting the objectives of those drivers, or those trends.”
Business drivers are more along the lines of government mandates and an aging population, which some of the groups had mentioned. “That’s the level of abstraction I want you get to,” he says. “Think out in the marketplace.”
When it comes down to it, Dr. Guthrie explains, the hospitalist plays a role in just about every measurement used to determine excellence at a hospital—from quality to customer loyalty, from retention of patients to productivity.