Are You In or Out?

Posted on February 12, 2014


“I mean, say what you want about the tenets of National Socialism, Dude, at least it’s an ethos.”  Walter Sobchak to The Dude in The Big Lebowski

I think busy professionals, especially experienced ones, feel like new business ideas are trendy (look at the business best seller list), and if you somehow fall for the latest ‘get results now’ idea you are irresponsible and an awful brand of sucker.

The germination period from a passing interest to guiding organizational principle is long, with many opportunities to be starved off.  And yet, what is today’s key operating principle if not a yesterday trend with staying power?  What imbues a supposed trend in healthcare with gravitas—elevating a catchy idea to something worthy of education and sustained application?

Substance helps lend legitimacy.  The challenge is to first identify, and then adopt, impactful change for your hospital.  Adopt in the sense of absorbing all that something entails, good and bad, and derive principles for action.  For competitive advantage, a keen reasoned approach is needed.  Application with nuance.  An ethos about the subject is needed.

For example, Constitutional scholars often debate the meaning of certain phrases in our nation’s founding documents.  Our Supreme Court’s job is to interpret those words into meaning that can be used as a basis for judgment.  Behind the letter of the law lies its intent.  Understand intent and you can have a meaningful discussion about the Constitution and then apply it to craft law.  Apply shallow knowledge at the face-value level, and it will be ineffective.

A similar approach is needed in healthcare.  Here are three themes that have stuck around healthcare, and perhaps more importantly, have quietly become major opportunities for either attracting more patients or lowering costs.  With the right ethos, they can assist in massive change.

Example 1:  Sustainable Design.  Once believed to be a green blizzard that would blow over, sustainability has matured.

Past trendy dictate:  “All buildings will be LEED Silver or better.”

Smart ethos action:  Engineer a sustainable supply chain of all materials in the hospital; apply sensitive management of the hospital’s campus and landscape; institute ways of working internally that use fewer resources.

Example 2:  BIM.  Facilities folks dismissed BIM as just a slightly improved, next evolution of drawing tool after AutoCAD (which, by the way, became the de facto digital standard after physical blueprints).

Past trendy dictate:  “My whole campus is on AutoCAD.  BIM just adds cost.  Let’s wait and see on this”.

Smart ethos action:  Build  and maintain a BIM model for an integrated, campus-wide planning tool that can help monitor, manage and unify such disparate parts of a hospital as master planning, departmental efficiency metrics, campus standards, real estate, infrastructure, supply chain, utility usage, security, and infection control.

Example 3:  Lean / Six Sigma.  Lean and Six Sigma work hand-in-hand to improve efficiency and quality, respectively.  Lean eliminates waste in work processes; Six Sigma makes sure a process or activity, once optimized, can be repeated by all team members each time.

Past trendy dictate:  “Lean is a manufacturing technology; this is healthcare.  We’ll send someone to a conference to learn more when we’ve got the budget, next year.”

Smart ethos action:  Healthcare is a process-driven driven business with much to gain from increased efficiency and improved quality.  Let’s start looking at how we do things department-by-department, with particular emphasis on the departments with big revenue impact like the OR, ED, and Imaging.

Change is constant.  Stasis, in business, is death.  While some hospitals find a cause to rally behind, business-wise, others are choosing to not play, to opt out.  That works if you are waiting for the right hand to come along to push your chips ‘all-in’.  Otherwise, you will be slowly bled dry watching the game pass you by.  Some big ideas will stick around and thrive; others will wither and die.  But it is naive to be dismissive of all new business ideas as fads.

Have courage to investigate a potential big idea, back it, and embrace it as an ethos that will power your hospital forward.  Commit.  Or pass over it and look for the next big idea, the one you need.  Whatever you do, have a reasoning and don’t check a box.  Half-hearted attempts to institute meaningful change never work, so the question for healthcare systems:  are you in or out?