Is lack of attention to "The primary purpose" killing the medical field?

madwife2002, BSN, RN · May 25, 2011

Interesting I really enjoyed reading your post, thank you

CCRNDiva, BSN, RN · May 25, 2011

That's funny!! My hospital has valet parking and sells jewelry in the newly renovated gift shop, yet they're cutting staff, raising staff ratios and cutting pay :rotfl::rotfl:

FF-PHRN · May 25, 2011

My hospital is starting to offer automotive detail service in the ambulance bays. ER staff will be washing\waxing the pt\customer vehicles while they are being seen. Should be a nice way to fill in staff down times......

OK, maybe not. Thats just as reasonable as the jewelry sales, book sales and every other wild hair sale that comes up.

Hospitals doing only healthcare would be a novelty.

mariposabella · May 25, 2011

Greed that is all it is. Pure greed. Isnt that the American way of life? How to get more and more money? Great post!

chicookie, BSN, RN · May 25, 2011

Let's see, the hospital where I work has 2 gifts shops, 2 coffee shops, and monthly sales of something or another. Sometimes its jewelry, sometimes its electronics, sometimes its movies/books, oh and recently they added a Chick-fil-a (which I might add charges more for their food than a regular Chick-fil-a) Plus the two other places we have to eat now charge for those little packets of jelly, butter, creamer, plastic cups and plates.

Sometimes when I walk down the main hall I feel like I am at the mall not the hospital...

And you know what I love the most, today in our hospital newsletter it had a list of benefits of working here and my favorite one: free parking (who cares that our parking is 4 or 8 blocks away and we have to take a shuttle to get here.) So I am sure once they stop being nice to us they will start charging us parking too. -__________-

eriksoln, BSN, RN · May 25, 2011

my hospital is starting to offer automotive detail service in the ambulance bays. er staff will be washing\waxing the pt\customer vehicles while they are being seen. should be a nice way to fill in staff down times......
ok, maybe not. thats just as reasonable as the jewelry sales, book sales and every other wild hair sale that comes up.
hospitals doing only healthcare would be a novelty.

don't laugh............it could be coming down the road. :cool:

my hospital kinda went this direction. they got a few people to come in on off days and do a community car wash. the emails said the focus was on getting to know the people in the community. we'd do car washes in the front parking lot on weekends and really show how we are community oriented. one email even suggested "we will have better relations with family members too, since they will already have a relation with the hospital when a loved one is admitted."

ok then. cheesy as all heck and not going to work, but at least admin. is showing some signs of (not very) intelligent life.

oh, wait a second. what they forgot to mention was that they were charging the people from the "community" for the car wash, charging more than the local professional car wash station. mind you, the people who were doing this event were all volunteers, their pay for spending 4 hours of their off weekend in the hospital parking lot.....................lunch, at the hospital cafe..............not allowed to exceed $4.

one of the night housekeepers found out about the fee they were charging and wrote a (from what i understand) nasty email to the person who organized the whole thing. a few days later, there was an email sent out to everyone about how the fee was to cover the employee lunches and the rest would be used at the next car wash event. hardly anyone volunteered for the second one, i've heard as high as 4 and as low as 2 for the number that showed up.

FLmomof5 · May 25, 2011

Greed that is all it is. Pure greed. Isnt that the American way of life? How to get more and more money? Great post!

Is it greed? Really?

In the OPs post, it was mentioned that customers were getting frustrated with the change machine giving less than full value. Also...they weren't able to use all of the machines because they didn't function properly.

The OP is so very correct that the owner of the laundromat would have been better off sticking with what works.

Here is the disconnect....providing the medical care alone isn't working. Medicare/Medicaid reimbursement rates are at or below the cost of service. Insurance companies have also restricted reimbursement and care. Lawsuit happy folks have driven up the cost of doing business for both the hospitals and the doctors. The issues are complicated, interwoven and cyclical (as in what goes around comes around)....but the bottom line remains the same....the level of profitability of providing pure medical care is decreasing.

It sounds like the CEO is trying to add something that is more profitable. Believe it or not, there is about a 300% markup on jewelry! Try doing that with a CAT scan! Honestly, I think a simple gift shop is OK, but the level of other "mall" like kiosks is getting borderline silly.

According to Forbes: "The median operating margin for 200-bed hospitals and above was slightly negative (-0.7%) last year. That means the money that was brought in from patients fell short of what they needed to spend on staff, equipment, buildings and other items."

[http://www.forbes.com/2010/08/30/profitable-hospitals-hca-healthcare-business-mayo-clinic_2.html]

Yes, there are *some* hospitals that are very profitable, but as the article shows Mayo, as an example, uses the funds from its profitable hospitals to fund at least one unprofitable one in the south and to open another one in Jacksonville.

That is not greed.

Yes, some CEOs have extraordinary incomes. They were brought in to help get some profitability. (We may disagree with these silly little shops and valet parking, et.al., and the majority of their methods, but they probably thought: we gotta try SOMETHING.) You cannot operate a hospital in a vacuum! The bills have to be paid, salaries met, equipment purchased and/or maintained....all the while you have a demanding public that wants the best of the best for the least.

I don't have the answer. If I did, I would have the CEOs job! But, I think there are too many out there trying to villify that which should not be.

Let's back up...WAY back. There were things out there called manufacturing corporations. They paid a wage to their employees, most of whom, only had a HS education. They had job security. They felt underpaid. They saw those "enormous" checks of the elite that ran the company and felt it unfair. They formed unions. They demanded MORE. They got their pay raises, their "takes an act of God to fire you" level of job security, medical insurance (silver platter level) and fantastic retirements.

To fund this, the manufacturers raise the price of the products. The foreign products were now cheaper and more affordable than the domestic products. The majority of the population could better afford the foreign products so sales monopolies on this side of the pond decreased.....

In the meantime, the greatest education in the world began producing the greatest medical innovations as well. To pay for these innovations, prices increased. To pay for the greater increase in reimbursements, insurance companies had to increase premiums or they would go bankrupt. This then fell back on to the employers.... $15K per employee for medical insurance? OK...so they started charging the employee a portion. Folks screamed about that, so HMOs were created to manage costs.

All the while, law schools were pumping out legions of lawyers. We joke about the "ambulance chasers", but they are some of the best compensated lawyers out there! To combat these lawsuits, malpractice insurance was created....and because the awards got larger and larger....the premiums to hospitals and doctors skyrocketed. That cost of business had to be passed on to the consumer (in the form of increased medical costs/co-pays/insurance premiums,etc.)!

Before the manufacturing revolution, people were happy with getting a paycheck to raise their families. Then we went for paid holidays, vacations, medical, dental, education, retirement.....these aren't free. They have to be paid for. The guy that risked everything he had to create a business can't just hire an employee for a wage anymore. He is the one who took the risk so that you could have a job. He deserves to be compensated for his success.

There is an implication being propagated by the media that it is corporate greed (of the upper eschelons) that is creating the train wreck this country is headed for. Did it not start at that lower level? When being paid a days wage for a days work was no longer good enough...?

Think about it for a second. The MAJORITY of 200+ bed hospitals run below breaking even! The populace wants perfect outcome from their medical care and will sue (even when unjustified) if they don't get it! (God forbid you have a less than perfect baby, for example.) The employees at the hospital want maximum wage and they want maximum benefits and a low patient ratio. You as the owner of that hospital want the hospital to succeed....so you hire the best CEO you can find. He may not be "cheap", but he is there to create profitability.

The untouchables: You cannot raise prices anymore because the insurance companies won't give the reimbursement and the government will give even less. You have to ensure "perfection" (or at least "pleasing") in hospital experiences for the patient. This will reduce the likelihood of lawsuit. You still are expected to purchase the latest and greatest equipment even for rural/semi-rural areas.

Business is all about managing costs. So, for all our nurses here.....if you were CEO, what would YOU do?

In another post a while back, I showed how taking away the CEOs pay wouldn't increase nurse pay by more than a token. Another point I would make is that if YOU, the nurse, felt you could do better and got your MBA and then the CEOs job.....I would believe that you would feel you EARNED that pay.

emtb2rn, BSN, RN, EMT-B · May 25, 2011

I'm going to play devil's advocate.

The gift shops, valet parking, concierge service, flat screen tvs, wooden floors and all the other seemingly foo-foo, unecessary, wasteful add-ons are investments with a specific goal in mind. Elective procedures. That's where the money is and those are the folks who can afford it. That's the market the hospitals are trying to attract. I guess we'll see if the roi plays out as expected.

allnurses Guide · May 25, 2011

I thoroughly enjoyed that post!

You put into words what I have thought many times and I found your friend's experience with the laundromat, not only interesting, but a fabulous comparison to what is wrong with hospitals.

Nice.

allnurses Guide · May 25, 2011

oh, wait a second. what they forgot to mention was that they were charging the people from the "community" for the car wash, charging more than the local professional car wash station. mind you, the people who were doing this event were all volunteers, their pay for spending 4 hours of their off weekend in the hospital parking lot.....................lunch, at the hospital cafe..............not allowed to exceed $4.

what a bunch of jerks!

eriksoln, BSN, RN · May 25, 2011

Is it greed? Really?
In the OPs post, it was mentioned that customers were getting frustrated with the change machine giving less than full value. Also...they weren't able to use all of the machines because they didn't function properly.
The OP is so very correct that the owner of the laundromat would have been better off sticking with what works.
Here is the disconnect....providing the medical care alone isn't working. Medicare/Medicaid reimbursement rates are at or below the cost of service. Insurance companies have also restricted reimbursement and care. Lawsuit happy folks have driven up the cost of doing business for both the hospitals and the doctors. The issues are complicated, interwoven and cyclical (as in what goes around comes around)....but the bottom line remains the same....the level of profitability of providing pure medical care is decreasing.
It sounds like the CEO is trying to add something that is more profitable. Believe it or not, there is about a 300% markup on jewelry! Try doing that with a CAT scan! Honestly, I think a simple gift shop is OK, but the level of other "mall" like kiosks is getting borderline silly.
According to Forbes: "The median operating margin for 200-bed hospitals and above was slightly negative (-0.7%) last year. That means the money that was brought in from patients fell short of what they needed to spend on staff, equipment, buildings and other items."
[http://www.forbes.com/2010/08/30/profitable-hospitals-hca-healthcare-business-mayo-clinic_2.html]
Yes, there are *some* hospitals that are very profitable, but as the article shows Mayo, as an example, uses the funds from its profitable hospitals to fund at least one unprofitable one in the south and to open another one in Jacksonville.
That is not greed.
Yes, some CEOs have extraordinary incomes. They were brought in to help get some profitability. (We may disagree with these silly little shops and valet parking, et.al., and the majority of their methods, but they probably thought: we gotta try SOMETHING.) You cannot operate a hospital in a vacuum! The bills have to be paid, salaries met, equipment purchased and/or maintained....all the while you have a demanding public that wants the best of the best for the least.
I don't have the answer. If I did, I would have the CEOs job! But, I think there are too many out there trying to villify that which should not be.
Let's back up...WAY back. There were things out there called manufacturing corporations. They paid a wage to their employees, most of whom, only had a HS education. They had job security. They felt underpaid. They saw those "enormous" checks of the elite that ran the company and felt it unfair. They formed unions. They demanded MORE. They got their pay raises, their "takes an act of God to fire you" level of job security, medical insurance (silver platter level) and fantastic retirements.
To fund this, the manufacturers raise the price of the products. The foreign products were now cheaper and more affordable than the domestic products. The majority of the population could better afford the foreign products so sales monopolies on this side of the pond decreased.....
In the meantime, the greatest education in the world began producing the greatest medical innovations as well. To pay for these innovations, prices increased. To pay for the greater increase in reimbursements, insurance companies had to increase premiums or they would go bankrupt. This then fell back on to the employers.... $15K per employee for medical insurance? OK...so they started charging the employee a portion. Folks screamed about that, so HMOs were created to manage costs.
All the while, law schools were pumping out legions of lawyers. We joke about the "ambulance chasers", but they are some of the best compensated lawyers out there! To combat these lawsuits, malpractice insurance was created....and because the awards got larger and larger....the premiums to hospitals and doctors skyrocketed. That cost of business had to be passed on to the consumer (in the form of increased medical costs/co-pays/insurance premiums,etc.)!
Before the manufacturing revolution, people were happy with getting a paycheck to raise their families. Then we went for paid holidays, vacations, medical, dental, education, retirement.....these aren't free. They have to be paid for. The guy that risked everything he had to create a business can't just hire an employee for a wage anymore. He is the one who took the risk so that you could have a job. He deserves to be compensated for his success.
There is an implication being propagated by the media that it is corporate greed (of the upper eschelons) that is creating the train wreck this country is headed for. Did it not start at that lower level? When being paid a days wage for a days work was no longer good enough...?
Think about it for a second. The MAJORITY of 200+ bed hospitals run below breaking even! The populace wants perfect outcome from their medical care and will sue (even when unjustified) if they don't get it! (God forbid you have a less than perfect baby, for example.) The employees at the hospital want maximum wage and they want maximum benefits and a low patient ratio. You as the owner of that hospital want the hospital to succeed....so you hire the best CEO you can find. He may not be "cheap", but he is there to create profitability.
The untouchables: You cannot raise prices anymore because the insurance companies won't give the reimbursement and the government will give even less. You have to ensure "perfection" (or at least "pleasing") in hospital experiences for the patient. This will reduce the likelihood of lawsuit. You still are expected to purchase the latest and greatest equipment even for rural/semi-rural areas.
Business is all about managing costs. So, for all our nurses here.....if you were CEO, what would YOU do?
In another post a while back, I showed how taking away the CEOs pay wouldn't increase nurse pay by more than a token. Another point I would make is that if YOU, the nurse, felt you could do better and got your MBA and then the CEOs job.....I would believe that you would feel you EARNED that pay.

OK. I get what you are saying, but what do you say to:

1. My hospital has 10 VPs. Let me say that again for emphasis....................TEN VICE PRESIDENTS. My hospital is either a small/mid-sized hospital or a large/small hospital. A much larger hospital in the area employs 3 VPs. Well say that one twice also, THREE VICE PRESIDENTS. That means my hospital is overstaffed, at the administrative level by at least 7 VPs. Getting rid of one CEO may not help much, but you can really staff for quality without the weight of seven VPs pulling your finances into the red.

Mind you, I stressed as one of my points in the OP that my hospital paid money for a consulting company to come in and show them how to schedule for census trends. Now, IDK, maybe I expect too much from someone who accepts a six figure salary but......................is that not their job to begin with? How does it make sense that you are paying an outside company to make those decisions for you? If that consulting company were worth a nickel, I know what their first suggestion of where to cut back was.

2. Right before the recession hit, the large hospital I mentioned above in my area performed a death march on its administration. They went through the hospital, pulled the "suits" into a room and interrogated them. They were asked what their role was and how they contributed to the hospitals daily functions. When all was said and done, a reported 30M in salary had been shaved. Now, IDK about you, but that says to me there was 30M(plus)/year waste going on that was so easily detected, they evaporated it in one march through the hospital. Why'd it take an impeding recession to do that? Are all these unnecessary "suits" being brought back when things improve, and if so, why?

A couple months after this "death march" in my local town occurred, the same happened in Seattle (I was there, travel nursing) with hospital of comparable size shaving 20M. Coincidence? Mmmmmmmmmmmmmm..........thats a hard sell.

Point is, if hospitals are doing so poorly, they must change. My friend with the laundry-mat failed to change once things started down the wrong path...............and/or his changes were not "primary purpose focused".

One of the most significant/important changes you can make to a dying industry is to stop waste. I have to say, I am confident in my opinion that the majority of the waste that goes on in the medical field is with admin. salaries. May as well start with the biggest problem then move forward to smaller ones. The six figure salaries come with a price tag, and said price tag is that if the business fails...............you've failed as an administrator, no excuses. So, if hospitals are running in a deficit..................the natural consequences are that admin. needs to go. Thats their job to make it better.

Not saying there are not problems on the ground level too, but really, we talk a lot about what we want and all, but no one really gets it. We want better ratios............thats well documented, but no one has them. We want better pay rates and benefits.............don't have them either. So, eh..........I don't think the problems with the labor are "the problem". I've met the nurses who think because they have two years more than their co-worker they should always have a set schedule, a higher pay rate, more vacation, less patients................blah blah. Won't hear anyone complain if they are cut. Besides, their demands cause stress on us, not the budget.

See, you compare what workers want to what admin. makes and say it's too much. Problem is, you are comparing a want (something not happening, thus its not affecting the budget) to a reality (admin. really does get their salaries, its not a want). That comparison doesn't work for me.