President Eisenhower once said, "Its easy to be a farmer when the farm is 900 miles away and your plow is a pencil", referring to the ineffectiveness of the federal government to direct farming activities from Washington DC. My experience in healthcare has been similar.
Large, national, for-profit healthcare companies have made many positive contributions to healthcare in America by leveraging their size and capital to build hundreds of hospitals, expand hospitals into rural and underserved areas, and use competition among providers to drive efficiencies, outcomes, and patient satisfaction. But in growing too large, a company can easily risk losing touch with each individual hospital and its unique, community-based challenges. Former Speaker of the House Tip O'Neill used to say "all politics are local" and the same is true of healthcare management.
One of the hospital companies I worked for in the past was bought out by a larger, more national competitor...so far, so good. However, I should have sensed the impending doom when someone called from our "new" corporate headquarters located halfway across the country to discuss information technology needs and started the conversation by asking where we were located. I named the city and he asked "what state is that in?" and when I answered, then asked me to give him a rough idea as to what major cities were nearby. Now this wasn't a recruiter or a consultant cold-calling for business, this was a member of "senior leadership" who could not find one of his "own" hospitals on a map...and hadn't even bothered to google us or our location.
So, okay, its a big country and this was a big company so maybe my expectations were set alittle high, but this lack of knowledge about local conditions was compounded by a corporate culture of control and centralization, i.e., "Don't make any decisions unless we give you the green light" which meant I had no authority to adjust to changing local conditions and no one at corporate had the insight into local conditions that we had...being local, after all.
It reminded me of a job I had when I was in grad school. I was a DJ in a 50's-themed bar/restaurant in Baton Rouge that was owned by a national company based in Dallas. Now I had been a DJ for years and had just left one of most successful clubs in the city, so I pretty much knew my way around a turntable and knew how to keep the dance floor packed. But this company was smarter than us hicks in Louisiana and had a "national director of entertainment", based in Dallas, whose job included faxing a playlist to each DJ in the field, each day, listing which songs to play in which order...."4:01 pm: Round Around the Clock; 4:04 pm: Earth Angel" and so forth.
The problem is its easy to be the DJ when your club is 900 miles away and your turntable is a fax machine. I was forced to play the wrong song at the wrong time, time and time again, and watch the crowd drift away. I had been warned that varying from the playlist meant instant "de-hiring" but, one day, I had finally had enough, dedicated "With This Ring" to a couple celebrating their 40th wedding anniversary and watched the dance floor fill. My manager raced to the booth and told me if I did that again, it was my job. I told him: "Jack, see that record right there? Its going to run out in about 2 and a half minutes. Think fast", took off my headset, and walked out of that club with The Platters singing "with this ring I promise to always love you..." as I hit the parking lot. Never even went back to pick up my last paycheck. Moral of the story? That company went out of business in less than 18 months.
The challenge with healthcare management is the same, I think. In order to benefit from the opportunities a national presence affords a company, the company has to hire good local hospital operators and then learn to get out of their way. All healthcare is local, so the management must be, too.
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