At our hospital, I am the Chief Operating Officer and an RN and came up through the ranks of nursing. Our Chief Nursing Officer is an RN (naturally) but she also has other non-nursing departments that report to her. Our CEO is a lab tech that came up through the ranks of the lab. Our CFO is an accountant. We run our hospital. We are clinicians who have gained additional finance and business education and skill (except the accountant). There are 7 other hospitals in our market, both for-profit and not-for-profit. We have a waiting list of people who want to come work for us in our nursing, lab, and radiology departments. We have nurses who quit this hospital 5 years ago who have come back and those waiting for an opening to come back. We have completely eliminated the need for agency nurses (as of last October).
We work for a for-profit hospital corporation, very bottom-line oriented and sensitive to the stock market, very short term thinkers and engage in knee-jerk reactions to quarterly earnings. They have repeatedly done idiotic things to cut costs.
We have created a little "pocket" in our market where the focus is on good patient care. Our philosophy is simple, if the staff nurses don't succeed in their jobs, we in administration don't succeed in ours. If we deliver a quality product (healthcare) then patients and doctors want to use our facility over and over. If we have patient and doctors coming back repeatedly, then the money is there. If we have an effective balance in reinvesting in our organization, then our revenues exceed our expenses and the doors stay open and our employees are compensated satisfactorily.
Five years ago this hospital was considered the bottom of the barrel by doctors, the community, and employees. Volumes and market share were falling. The corporate guys were doing what corporate guys usually do, cut costs, cut benefits, cut salaries, reduce numbers of staff, change the staff skill mix so less RNs, and so on as many of the nurses that post here have described. The hospital was dirty, run down, equipment old, etc. Nurses were quitting left and right and our agency nurse usage was through the roof.
Our current management team inherited this hospital. We created a concept we call service excellence. We realized the value of nurses and other clinicians in creating a good hospital. We set up a system that gave a tremendous amount of autonomy to the various managers to run their units as they saw fit with good patient care as the sole objective. We asked the nursing staff and other staff what they thought we needed to do to improve. We set up a system that allowed them to voice their opinions and ideas. We implemented those ideas. We got results. We convinced the corporate guys to give us the opportunity to try our new approach. They listened. Why did they listen? Because we have clinical people with finance and business skills running this hospital who understand the environment we work in, who understand the mentality of the corporate people, who understand how to talk to them, and who know how to provide the data they want to see in order to gain approval for various initiatives for change.
We are not where we want to be yet, but we are well on the way. Are we the "utopia" of American hospitals? No. We have made unbelieveable progress and continue to do so. When you walk in our front door you can feel the positive and energetic atmosphere. Our staff are truly glad to be at work and are very proud of our hospital. I get visitors in my office regularly who comment on this. I have vendors and salepeople who call on multitudes of hospitals that ask me what we have done here, who tell me that our hospital is truly different than others.
I could into more detail than you want to know (probably) about the various things we have put in place that have made a difference. The bottom line here is that we have nurses and clinical people in the positions of decision-makers, that have the authority to change things in the hospital and have patient care as the center of everything we do. We see it that way and we expect anyone who works with us (not for us, we are a team) to share the same view. We do not want our organization contaminated with negative, griping, greedy, cost-cutting people. We carefully select who works for us. We do not accept other corporate officers that our corporate headquarters tries to send us that are "bottom liners." We stand up and say no and we clearly communicate what we want and need to keep our hospital a great place to work.
We did all of this without a union and without creating an adversarial relationship with our corporate office because we have nurses and clinical people who run this hospital that understand finances and business as well.
We need more nurses willing to step up and assume positions authority and decison-making. More nurses who will learn the finance and business side without forsaking their dedication to good patient care and who will not succumb to greed. They are out there.
Those are a few of my tips.