Re: Risk taking and organizational issues

[Guest guest]

Mark;

Your thoughts about our healthcare " system " are right on the money! It

truly is reactionary, at best. Indeed, it really is a contradiction to call

it a " system " since that implies some degree of thoughtful organization....

We indeed work in a " reactionary " environment. I'd add further to that

point by suggesting that the reason this is true is because this country has

not determined whether access to healthcare is a " right " or a " privilege " .

In fact from my perspective it seems that this most fundamental

philosophical debate is being avoided like the plague by politicks because

they might not like what the rank and file citizens (and ?residents) of this

country believe and want related to healthcare! Right now it is a

privilege, and worse it has multiple levels. The result? Perpetual cost

shifting with astonishingly conflicting incentives and disincentives among

all the factions that have a part in the entire industry (patients, payers,

providers, etc.).

Until we have this debate, and resolve the question of right vs. privilege,

(and if it is a " right " what does the basic elements include), then I think

we will continue having to deal with this shell game of conflicting agendas,

incentives and disincentives.

Can you guess what my philosophical lean is on the topic?!!!!!

E. Arslanian, MS, PT

Director of Rehabilitation Services

Brigham & Women's Hospital

Boston, MA

Use either e-mail address:

larslanian@...

larslanian1@...

> Re: Risk taking and organizational issues

>

>

> >Kathleen,

> >

> >Thanks for your posting. It is interesting to note your comment about

> the

> >tone of our discussions. I hope the members of the list will take your

> >comments to heart. Thanks for pointing out what may not be obvious to

> some

> >of the list veterans - manners matter.

> >

> >Concerning your comments on the delivery of care to our patients. I

> think

> >you are right on that we have not yet figured out the best way to care

> for

> >these patients given the extreme financial limitations often imposed by a

>

> >variety of parties.

> >

> >My thoughts are that maybe what we lack here is an alternative way of

> >viewing the problem. Since we are often so caught up in the day to day

> of

> >reimbursement and case management that we tend to HAVE to consider that

> >aspect, we may be somewhat blinded to the fact that we have probably over

>

> >structured our care around our needs (for reimbursement, coordination of

> >our staff, locations etc) that we have failed to establish mechanisms to

> >adequately care for the patient - and their needs.

> >

> >To some extent, it seems we have created our health care systems and we

> >have created our reimbursement models - both substantial undertakings -

> but

> >we then try to make the patient " fit " into our structures. That does not

>

> >seem to be working very well from my perspective.

> >

> >We may be facing something of a paradigm shift here. I wonder if our

> size

> >and complexity (although often required to address the scope of some of

> our

> >most complex patients) has created such an intense level of inertia that

> >our systems can simply not adapt. There may be some argument for

> smaller,

> >more adaptive organizations. Clearly, this will need to be balanced with

>

> >the overwhelming self-survival instincts that all organizations

> eventually

> >develop.

> >

> >There are advantages and disadvantages to size and complexity. We have

> >seen these illustrated in our large vs small educational institutions,

> our

> >medical centers vs community hospitals, and in our private practices

> (true

> >entrepreneurial practices) vs large corporate entities.

> >

> >It seems we have made some choices about how we will be organized and

> >structured. These decisions were probably logical at the time that they

> >were made. I would challenge us all to go back and re-visit those

> >decisions. Have they worked out to our best advantage? have they been

> to

> >the patients' and community's best advantage? If not, is there anything

> >that can be done.

> >

> >Finally, (is this starting to sound like a Dennis rant?) I want to

>

> >share one of those " aha " moments that I had recently:

> >

> >We have always defined an entrepreneur as " someone who takes risks " .

> This

> >has often meant the private practitioner as compared to a therapist who

> is

> >employed in someone else's practice. The employee was thought to be at

> >less risk because they had a job - a steady (usually substantial) salary

> >and good benefits. The business owner was considered to be more of a

> risk

> >taker because they had invested in their business and it could fail so

> that

> >they would lose it all.

> >

> >Has not this scenario completely reversed itself in the past year or so?

> I

> >have received so many calls from therapists who were down-sized, laid off

>

> >or just plain fired recently, that it seems that the real risk takers are

>

> >those who are employed and at the will and whim of a single employer.

> Many

> >of the practice owners or other " entrepreneurs " are in much more stable

> >situations. Many of the past employees have told me that they did

> >everything that they could but the company folded or was sold/merged so

> >that they really could not control their own destiny.

> >

> >Question: Are today's employed therapists really the risk takers? I

> don't

> >suggest that the risk of private practice has decreased any - it probably

>

> >has not - but the risk of employment sure seems to have gone up. That is

>

> >quite a revelation to me.

> >

> >Sorry for the length. I'd love to hear other comments on this - either

> >through the list or direct to me.

>

>

>

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