Every hospital in Los Angeles shares three universal goals: 1) to provide quality care; 2) to remain nimble enough to respond to the changing needs of its community while remaining true to its mission; and 3) to operate in a way that assures long-term sustainability. While the Affordable Care Act has changed much, these truths remain constant.
What has changed, however, is not the what but the how. Precisely how Los Angeles County’s 122 hospitals will achieve these goals while also assuring access and affordability is where today’s uncertainty lies.
The answer may be found in new-era thinking where collaboration trumps competition and where the health care industry finds its equilibrium by focusing on our collective rather than individual good. This is not a unique notion. Already, hospitals bond together routinely to advocate for principles in which we all believe. But I believe it is time to do more in our own communities and through our own institutions, not only for our good but for the good of those we serve.
Clearly there are many options, but let me suggest a few examples:
• Unlike nearly every other industry in America where competition leads to consumer cost savings, duplication of health care services actually increases cost. If one hospital is a trauma center and another opens down the street, they both need to invest in expensive equipment, 24-hour staffing and other costly requirements that accompany their designation. But doubling the number of centers does not equate to doubling the number of patients – so the cost for everyone goes up. Let’s be sensible in our planning and avoid unnecessary duplication of services.
• Not all care is best done in a hospital setting. In fact, most is not. Hospitals need to move from a volume-based to a value-based mindset and not only encourage our community members to seek care in the best location but, as important, be accountable for their health. Options might include a physician’s office, a freestanding outpatient center or an urgent care center that can handle patients who might otherwise be contributing to overcrowding in a hospital-based emergency department. Right care, right place, right time should be the rule.
• Rather than always looking for new programs to provide, or obtain the latest new, but expensive technology, hospitals should explore creative partnerships with others that share their mission, values and vision as a way to serve their community and to make our health system work better. Last year, for example, Huntington Memorial Hospital entered into an agreement with Shriners Hospitals for Children-Southern California to provide inpatient surgical services for its pediatric patients. Shriners Hospital’s physicians were granted privileges on Huntington’s medical staff, and children who need inpatient services are now cared for by Huntington’s team of nurses, pediatric hospitalists and occupational and physical therapists, and other health care professionals. By working together in this manner, everyone benefits.
• Hospitals need to invest time, energy and dollars not only in their own future but in the future of health care in Los Angeles as a whole. This could mean funding graduate medical education programs, launching (as we did in 2012) an Institute of Nursing that encourages career development and looking for other creative ways to assure that communities throughout Los Angeles will not be without the best and the brightest for years to come. The confluence of people living longer, baby boomers aging, and millions of newly insured entering the health care system through the Affordable Care Act makes the training of physicians, nurses, therapists, pharmacists and other health professionals more critical than ever.
L.A.’s health care providers can do a great service and actually improve our image by taking the high road and learning to act cooperatively and collaboratively where the greater good can be achieved.
Stephen A. Ralph is president and chief executive of Huntington Memorial Hospital in Pasadena.
