The young man was a wrestler on his high school team. He was a middle weight and considered one of the best high school wrestlers in the state. Beginning about a month before practice began each year he would begin drinking protein shakes, water, and limiting anything that could cause him to gain weight. Each week before a match during the season he would dress in double sweats and spend hours in the steam room. The morning after the season ended it was a never ending drive through! Within a month his weight jumped almost 40 lbs. This roller coaster weight ride continued through college. It has been three years since graduation and today the former All State Wrestler is a diabetic, hypertension, and at serious risk of a heart attack.
If you go to Weight Watchers, AA, any gathering of individuals who have made major changes in their life and there will be a number of stories like this. The other day there was a piece on CNN about the number of low income individuals that won a state lottery – only to end up losing their winnings within a few years. The ability to make real changes in one’s behavior is very difficult; some believe next to impossible.
Thomson Reuters’ Center for Healthcare Improvement report (November 2009) reported the median profit margins for four hundred plus surveyed hospitals increased from 0.37 percent in Q3 2008 to 8.4 percent in Q2 2009. In 2008 and early 2009 hospital leadership and governance saw investment income decline as a result of the global economic crises. Staff, managers, leaders began to reduce their workforce, terminate building projects midstream, cut any budget lines that were possible. 2009 began with travel budgets deleted, non-mission critical staff was taken out of the workforce. Salary cuts and increased patient responsibility for the cost of their care made headlines.
The work paid off. By the end of the year most healthcare industry leaders had managed the dramatic change much like their counterparts in other industries – cut back, question investment in new programs and services, reduce staff, and cost shift wherever possible. The way a number of leaders managed the change in equilibrium was much like the wrestler sweating down his pounds.
Years ago, a similar economic crisis occurred due to changes in reimbursement from the Centers for Medicare and Medicaid. Twenty-five years in the healthcare industry provided six events similar to the 2008 recession; each characterized by cost shifting, staff cuts, lunch budgets removed, and travel budgets entering a virtual world. The years between these milestone events saw staff increasing year after year, holiday parties becoming larger and grander, and bonuses appearing in paychecks.
The change in profit margins is an outcome to be celebrated. The American Hospital Association surveyed nearly eight hundred hospital executives and found access to capital improving. Moody’s Investors Service Inc. and Standard & Poor’s bond ratings for healthcare are improving. Shut down healthcare building projects have restarted in Indianapolis and it appears the gold ring of healthcare reform is slipping out of reach.
The former wrestler was just released from the hospital. He was wheeled to the main entrance with a small suitcase, laptop, prescriptions, and two new stents. His wife and son were waiting in the car to drive him home. As he came out of the elevator, three construction workers were heading to the sixth floor renovation and a group of twenty new staffers were being on a tour of the emergency department. Our wrestler overhead the COO and two physicians discussing the new HD Da Vinci surgical robotic installation while four administrative assistants were shocked their corporate credit cards had been reissued. Our wrestler’s cardiologist met him in front of the garage; he took advantage of the chance meeting to remind his patient about the need for lifestyle change. The wrestler thanked his physician and asked why he was leaving this hospital so early in the day. The physician told the inquisitive patient he was on his way to a meeting with the hospital board to sign paperwork for the group practice to be purchased by the health system.
Our wrestler was safely seat belted in the car. The boy in the back seat was so happy to have his dad home and suggested they stop for ice cream to celebrate. The family drove to the ice cream shop for a celebratory snack.
Behavioral change is very difficult to achieve. When it occurs it could save a life – or an economy.
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