Journal of Healthcare Management - May/June 2014 - (Page 166)
J o u r n al
of
H ealt H care M anage Ment 59:3 M ay /J une 2014
Scripps were going to meet our future needs. We recognized the need to deliver a
higher-quality product much more efficiently and at a much lower price-not just for
us to remain competitive but also so we could play a leading role in helping the
country stave off bankruptcy due to swelling healthcare costs.
One morning while sitting at the Papal Nuncio's compound (where we stayed at
night) overlooking Port-au-Prince, I said, "What a pretty morning," and I caught
myself, thinking, what am I saying? But from that vantage point it actually looked
very pretty. You could see the ocean, the U.S. hospital ship Comfort, and the airport in
the distance. We were high enough that we could not see the damage. I thought, this
is exactly what most of us do as leaders: We look down on our part of the empire,
our part of healthcare delivery, and it looks beautiful from our perspective. But later,
when driving horizontally through Port-au-Prince toward the hospital, there was
nothing pretty to be seen. That is our problem in healthcare: We always look down
from our own individual perspective, and it looks pretty. I wondered if we sliced our
operations horizontally, how would it look?
When I returned, we identified $150 million in operating variation across our
five hospitals-everything from staffing to supply use to quality variations. To take
waste out of the system, we sought to standardize our organizations to a best practice. I flipped the organization on its side, took the chief operating officers out of the
hospitals, and gave them horizontal corporate responsibility to identify best practices
and to drive the entire healthcare system toward those best practices. We moved to a
matrix management structure, whereby we still have an administrative team responsible for day-to-day care but also a horizontal team that analyzes variation in practice
and incrementally moves us toward best practices. By the end of fiscal year 2014, we
will have taken $300 million out of our operating costs while improving quality and
not laying anybody off, adhering to one of our fundamental philosophies to avoid
layoffs (a philosophy rather than a policy because it reflects the mutual loyalty
between staff and organization). We are now employing a value-by-design process to
take another $300 million in costs and waste out of the entire continuum of care
while providing high quality in part by bringing the joy back to the practice of
healthcare-which ultimately brings joy back to the patient.
The rest of my career will be spent redesigning the healthcare delivery system,
making it much more ambulatory, focused much more on keeping people out of the
hospital and keeping them well.
Dr. O'Connor: Scripps Health has been included on Fortune magazine's 100 Best
Companies to Work For list for 7 consecutive years, most recently placing in the top 25.
What is your strategy for making Scripps a great place to work?
Mr. Van Gorder: We have billions of dollars' worth of hardware and buildings,
but it is people who deliver care. I know how hard our people work, but I also
learned that sometimes managers and senior managers make assumptions about
what their people need instead of listening to their people. As we rebuilt our organization, we listened to our people and instituted a number of initiatives to reengage
166
Table of Contents for the Digital Edition of Journal of Healthcare Management - May/June 2014
Journal of Healthcare Management - May/June 2014
Contents
Interview With Christopher D. Van Gorder, FACHE, President and CEO of Scripps Health
Successful Strategic Planning for a Reformed Delivery System
You, Inc.
Assessing the Feasibility of a Virtual Tumor Board Program: A Case Study
Physician Clinical Alignment and Integration: A Community–Academic Hospital Approach
Employer-Based Coverage and Medical Travel Options: Lessons for Healthcare Managers
Composite Model for Profiling Physicians Across Domains of Care
Journal of Healthcare Management - May/June 2014
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