The Forgotten Middle of Health Reform - The Hospital C-Suite

Some books are undeservedly forgotten,
None are undeservedly remembered.

W. H. Auden (1907-1973), English Poet

March 17, 2012 - In 2006, James Hawkins, a former hospital administrator and I wrote Sailing the Seven “Cs” of Hospital-Physician Relationships (PSR Publications). The seven “Cs” referred to the psychological and political glue of hospital-physicians relationships – competence, convenience, clarity, continuity, competition, control, and cash.

Buyers stayed away from the book in droves, and it has been long forgotten.

But not by me. For me, hospital managers, executives, and leaders are the forgotten middle people, the squeezed ones, in the battle for health reform. They are referred to as members of the “C suite” – the CEOs (Chief Executive Officers), CAOs (Chief Administrative Officers), COOs (Chief Operating Officers), CMOs (Chief Medical Officers), CIO (Chief Innovation or Information Officers), CTOs (Chief Technology Officers), or alternatively as Presidents, Vice-Presidents, Directors, Managers, Program Directors, or Medical Directors.

These are the people in the middle – between the hospital and its medical staff, between the hospital and the community, between the hospital and its suppliers, between the hospital and health plans, between the hospitals and Medicare and Medicaid.

It is they who oversee the most expensive sector on the health care system. It is they who must defend the hospital when malpractice or “never-never” events occur. It is they who must confront the “double-headed monster”, to wit,”One can not run a hospital with doctors, and one can not run one without them.” It is they who face dismissal by the board or medical staff, when things go wrong. It is they who must take the hit from the $200 billion annual lowered Medicare and Medicaid reimbursements under Obamacare in the name of “savings.” It is they who must manage the transition from a volume based system to a value-added environment.

And lastly it is they who lead operations, patient care, case management, quality and risk management, compliance, medical affairs, nursing, health information management, finance, analytics, revenue cycle management, pharmacy, informatics, physician employment, hospitalists, emergency room management, government programs, business engineering, clinical operations, network development contracting, infrastructure, information technology, supply chain, marketing and sales, telemedicine, and emerging technologies such as robots.

In many respects, to the outside world, these roles constitute a thankless and largely anonymous task. Some of its leaders, like George Halvorson, CEO of Kaiser, and Richard Umbdenstock, President and CEO of the American Hospital Association, are in the limelight but most are not. To learn what these health care leaders are doing and saying, read Healthleadersmedia. com. I do. It is part of my daily routine.

In any event, I salute them, and as Benjamin Franklin so memorably said.

If you would not be forgotten.

As soon as you are dead and rotten,

Either write things worthy reading,

Or do things worth the writing.

Tweet: In the hoopla, hyperbole, and hype over health reform, members of the hospital “C suite” tend to be forgotten, yet they are the glue of the system.