Quality Talk
Quality Talk
Carolyn Boone Lewis, newly elected chairman of the Chicago-based American Hospital Association (AHA), joins us to share her vision of hospitals as "prudent and ethical" institutions capable of resisting the "growth for growth’s sake" mentality. Such was the challenge she issued in her acceptance speech as the first hospital trustee and African-American to be elected to AHA’s highest office. She explains that even as chairman of the AHA board, her perspective is one of a community trustee.
Her professional experience includes years of work with the U.S. Securities and Exchange Commission. She served in former President Jimmy Carter’s administration and later directed a staff of analysts responsible for reviewing the emerging mutual fund industry. Lewis is currently president of the CBL Group, which serves clients in the health care and securities industries.
Lewis’ long record of volunteer service includes involvement with the Joint Commission on Accredita-tion of Healthcare Organizations, the Health Care Financing Administration, and District of Columbia Hospital Association Board. In 1993, in recognition of her community service, then Mayor Sharon Pratt Kelly proclaimed Oct. 21 Carolyn Boone Lewis Day in the District of Columbia.
Q. From your trusteeship perspective, how do you see hospitals best dealing with the present pressure for improvement and seemingly slim chances for increased resources?
A. To be even more specific about resources, on a relative basis, they are shrinking and the needs are getting larger. I think hospitals best deal with it as a community-by-community kind of exercise, although there’s a lot to learn one from the other. It starts with a hospital or group of hospitals looking to see what the need is in the community or communities they serve. It’s sort of an inventory of needs and an inventory of available resources and services. Then you start to see where to place your resources.
You need to see where the gaps are, however. I think where you get into difficulty is where you don’t go through that exercise. That’s where you might create a lot of health care services that may be excellent but that do not necessarily meet the community’s needs.
Q. Are you implying that hospitals do better through collaboration than through competition with one another?
A. It absolutely implies collaboration. I think one of the best models is the Community Care Network Demonstration Program (CCN). It’s a program funded by grants from the Kellogg Foundation and the Duke Foundation. It is administered by a collaborative group. Group members include the AHA; the Health Research and Education Trust, which is a component of AHA; Washington, DC-based Catholic Health Association; and the Irving, TX-based VHA, a nationwide network composed of physicians and community-owned health care organizations. It’s an effort that looks to develop community care networks around the country. There are several demonstration projects.
It’s grounded in four principles:
1. community health focus;
2. community accountability;
3. a seamless community of care;
4. management within fixed resources.
And there are some great examples in these demonstration projects of hospitals working collaboratively with other hospitals and other entities to address community health needs and to effectively spend community health resources in a way that hopefully stretches the dollars to where they are most needed.
Q. Are the collaborative networks going to be able to stay on their economic feet once the grant monies phase out?
A. The demonstration projects have been going on for some years, and part of the effort built into the program is to help the participating hospitals, the demonstration sites, transition into a self-supporting mode. It’s the inventory of community services that starts to point out the gap. There’s the obvious gap in the uninsured and the underinsured communities. But you may find a number of service gaps in your community, dental health services, school health programs, low immunization rates, absence or dearth of substance abuse programs. When you do the inventory, these things jump out at you. Not connecting your resources with your community’s needs really sets a health care institution on the wrong path. (For contact information on CCN, see the editor’s note at the end of this column.)
Q. What will come of institutions that don’t follow the principles you describe?
A. A long time ago at a health care conference, I listened to someone say that he did his strategic planning by walking up and down the streets of his community. That was the core of this CEO’s strategic planning. He made the point that if you are providing needed services, you’ll always be there. If you’re providing services that everybody else is providing, that represent a surplus of the high-tech services, for instance, then you’re truly in competition with everybody else who’s doing that. And that’s a fight to the finish and everybody’s not going to be left standing.
It really comes down to the fundamental notion of doing well what you do best, and what is connected to your community’s needs. In my mind, that takes you right back to collaboration because there are some things you do well, and others that someone else might take the leadership with. It’s a process of pulling together resources across providers and across other kinds of service components in the community to meet the total needs.
Q. Economically speaking, what’s the price of such collaboration?
A. I could flip it over and look at the price of not collaborating. It makes good business sense to pool resources. It’s a leveraging of resources across institutions. It’s a leveraging of the political clout of many rather than a few. It represents the real value a hospital can have as a convener of the resources. A hospital can be a powerful catalyst in bringing all the resources together and shaping policy and direction through that kind of collaborative process.
Q. Are there any lessons or principles from the business community that hospitals might turn to for instruction?
A. It’s important for hospitals and businesses to be talking to each other on the front end. I’m a strong proponent of having people from the business community on hospital boards. In many industries, business has stepped forward and learned lessons in its management of information technologies and public relations. Even looking at the securities industry, where I was most involved professionally, there is the example of learning how to work with the regulator, government, in a way that’s more productive, more helpful, and less contentious. Those are lessons that a lot of industries have learned faster than we have in health care.
Q. What single difference do you want hospital patients to experience by the time you finish your term of office?
A. A restoration of the trust and confidence in the hospital system would make an extraordinary difference. I’d like to see patients and communities feel a stronger participation in the process of health management — a sense of participation with the health care providers at the hospital.
Q. Is that from the boardroom or from the hospital bed?
A. I’d like to see patients become more involved in their own health management. But again, it’s grounded in the whole notion of restoring the synergy and the trust between hospitals and patients, between hospitals and communities.
I would take, for example, the kinds of programs that we’ve had at Greater Southeast Hospital in Washington, DC, which have been very imbedded in the community. I have been on the board for many years. The hospital went through a serious, devastating financial crisis over the last couple of years. But Greater Southeast Hospital sits in a community that would be without a hospital if it closed.
That hospital was able to manage through a period of financial crisis, largely because it had always been there for the community and so the community stood up for it during these crises. Together we were able to work our way through the crises. New ownership came in to take over and put financial resources into the hospital to save it from failure.
But I think the seed and the leverage and the ability of Greater Southeast to manage itself were really planted in the community relationships that were formed over time. The hospital did not just sit there to receive patients to provide acute care. It found many ways to identify and address community needs that nobody else was heeding:
• Neighborhood blood pressure programs in partnership with churches. It trained volunteers to become certified to take blood pressure readings and sent them out to places like barber shops and beauty shops where people would congregate.
• Breast cancer advocacy centers and a breast cancer education and screening program.
• A child development center and a high school adolescent health center.
There are some very clear and dramatic changes taking place around us — the aging population, the politically driven reimbursement system, advancing technology — that are going to change the way health care is delivered.
The environment around us is bringing dramatic changes to our doorstep. The challenge for us is to get ahead of that, to understand how that influences the delivery of health care and to take the leadership in making it work for us and the people we serve. It’s an exciting challenge.
We could be doing things very differently, and we must! We will be doing things very differently, because everything is being done so differently around us, with the Internet and information processing and technology and the advances in science. It sparks a lot of interest on my part in getting out ahead of it and making it work for our patients and our communities.
[Editor’s note: To learn more about the CCN, contact Health Research and Education Trust, American Hospital Association, One North Franklin, Chicago, IL 60606. Telephone: (312) 422-2612. Web site: www.aha.org/hret.]
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