In this strange era of “not for-profit” healthcare, in which the institutional bottom line seems to be the most compelling number that hospital executives deal with, true collaboration for the “sake of the community served by these healthcare systems” often doesn’t exist. Competing for patients, especially the profitable ones, many institutional leaders and boards perceive little choice but to continue down their contentious paths of historic competition. Responding in a patchwork fashion to the needs and desires of their medical staffs, employees, and traditions, many hospital boards and executives have focused on institutional rather than larger community interests. The results in terms of healthcare quality and value have been far from ideal.

Imagine a community, perhaps a suburban location, within a large metropolitan area, with three hospitals. Each is similarly equipped and has doctors of similar and adequate competence. Each facility is doing enough surgeries to meet any published numbers around maintaining competence, but none are utilizing their resources near capacity.

Imagine something unexpected. The hospital presidents, medical staff, employees, and community representatives meet to talk about the situation. They agree to set aside their organizational agendas to consider the best use of existing resources to service the needs of the larger community. What would that conversation be?

Would it start with a hypothetical discussion of best practices? Would it go on to delve into a way to utilize shared resources efficiently and effectively? Would the group look at revenue sharing and cost containment across unrelated organizations? Would it address the creation of a culture based on patient centeredness, safety, quality and equity?

Perhaps the group would accept as a given, that all three hospitals needed to maintain their cardiac surgery units in order to fulfill the wishes of their smaller communities and medical staffs and to get the projected return on prior investments. Could they come up with an elegant win-win solution? Perhaps they would decide that each hospital would have a virtual monopoly on cardiac procedures for four months out of the year. They would pool their nurses and other staff, creating one team that would rotate through the three hospitals.

They would look at the cardiac surgeons at all three hospitals, and assuming they all met agreed upon criteria, credential them at all three hospitals. Perhaps the physicians would maintain their local allegiances, and schedule their patients differently so that they performed the majority of their work at their historically favored institution while maintaining some sort of limited privileges elsewhere for emergencies.

Now, instead of competing, the hospitals are collaborating to provide a solution for their institutions, their surgeons, cardiac teams and the community. The positive results of such collaboration are obvious. The surgical teams are performing more procedures and are probably becoming more proficient, leading to better clinical outcomes for the patients. The patients can still use their physicians of choice, and in many cases can still have the procedure at their hospital of choice. Resources are being utilized as fully as possible, and with a number of costs shared by the hospitals, because of more efficient staffing and less down-time, all three organizations derive the same revenue at a lower cost. The institutions, the physicians and the patients all derive benefit from such a thought process.

When will this conversation happen in the real world? Who will lead it?

Written by David Sorin, Esq. and Lynn Helmer, MD