During the tumultuous 1960s, William Petasnick was a political science major at the University of Wisconsin–Madison. A course assignment led to a career in health care almost by accident. In health care, he found opportunities to both make an immediate difference in society and to study and tackle long-term public policy challenges. Years later as president and CEO of Froedtert & Community Health System in Milwaukee, he remains fascinated by a field that is committed to improving the health status of our communities and making a difference in the lives of those we care for.
I came of age in the 1960s during a time of renewed social responsibility. Like many others in my generation, I wanted to positively impact the world we live in, and I wanted a profession that was more about making a difference than making money. I was committed to the concept of public service. The ’60s were a time of hope, optimism and a feeling that if we worked together we could truly make a difference.
I became involved in health administration almost by accident. I started out as a political science major, but while researching a paper on Medicare, then a new program, I interviewed administrators at the University of Wisconsin Hospital to get their perspective. When that conversation led to a broader discussion about the organization and delivery of health services and the role of the political process in health policy, I had found my vocation. Health administration combined my social responsibility orientation with my interest in public policy. Health administration has provided daily challenges and professional fulfillment every day since.
I have had the opportunity to work in a variety of settings ranging from the U.S. Public Health Service to an urban health system that includes a major academic medical center and a regional community hospital. Each experience has helped me to build a better understanding of what health care means to different people and different communities. My having lived and worked in different regions of this country amplified the old adage that all health care is local. Each provider and community has a different and unique set of needs and goals. The community is defined differently in each setting, but the universal truth is that health care is all about serving that community and improving the health status of the people who live there.
The current system has become increasingly fractured and is not sustainable. We cannot sustain a health system where an increasing number of our citizens lack coverage for basic health services or where access is a significant barrier to seeking needed health services. In order to meet our patients’ needs, we must make reform a priority. We need to find unifying solutions that meet the unique needs of our patients whether they reside in rural, suburban or urban areas.
We need to partner with the business community. Business leaders are frustrated, they are in a competitive environment, and they see costs mounting and feel caught between a rock and a hard place. Too often, they view us as just another commodity. They see us as contributing to the problem rather than contributing to the solution.
The complexities of health care and uncertainties about cost and value have eroded trust. For many businesses, value is their primary concern, making transparency about both quality and costs essential. To build trust, we must be candid about the fact that we are not as good as we should be and we must demonstrate that we are actively working to improve the quality of health care. On the price side, we need to work to simplify this complex environment so that businesses and our patients can better understand and evaluate costs.
In Wisconsin, we have taken strides in this direction through the creation of the Wisconsin Collaborative for Healthcare Quality and the Wisconsin Hospital Association’s PricePoint and CheckPoint initiatives. This helped to open a dialogue about both quality and price that benefits all stakeholders. (See sidebar.)
You build trust one conversation at a time. The AHA has reached out to key stakeholder groups, and hospital leaders should do likewise in their communities. Reconnecting to the community and embracing community governance can help build a shared vision for health care in each community and across the nation. We have an active board composed of community leaders. This helps to facilitate a dialogue and understanding that is invaluable in our planning and decision-making process. Board members offer the perspective of community leaders with a deep commitment to the core value of high-quality patient care. They also provide us with a framework for our decision-making process. I know within our organization we have gone back to the drawing board when we could not fully answer the board’s question: “Is this action truly in the best interest of the community we serve?”
We also must embrace accountability and collaboration as a form of stewardship. Health care has evolved into a competitive environment, and we must separate good competition that leads to improvement from competition that becomes divisive and counterproductive. Health care should be a cooperative effort to meet patients’ needs augmented by competitive efforts to improve quality by meeting or exceeding other hospitals’ quality benchmarks.
Certain competitive actions can cast doubt on the good will and good intentions of all hospitals. Hospital leaders need a formal way to establish best practices for appropriate business behavior in health care, and the AHA can help to facilitate this process through its regional policy boards and constituency links. We have to step up and set the standards for the field, or someone less knowledgeable about health care and less passionate about caring for our patients will set the standards for us.
We must ask ourselves if our conduct is true to our organization’s mission, vision and values. We also need to actively solicit and incorporate feedback about our performance from the communities we serve. Holding community listening sessions is one way to get this feedback—this strategy can be a real eye-opener.
We also need to develop a shared understanding and clear definitions of community benefit. If we cannot agree on what community benefit is, how can we expect outside stakeholders to understand the benefit we provide? The efforts of the Catholic Health Association and the VHA have set a pattern of consistency and mutual understanding of the term, but there is more work to do. We need to continue with this effort.
Elected leaders are also concerned about community benefit and tax-exempt status and sometimes have difficulty seeing the difference between those organizations that pay taxes and those that don’t. Studies such as the recent Government Accountability Office report have found that the difference in charity care provided by nonprofit and for-profit hospitals was not significant. It seems clear that if we don’t take proactive steps to address these issues, the federal government will become more proscriptive. It would be better for all involved if we reached a mutual understanding.
We also need to focus on our relationships with the physicians who care for our patients. The emergence of specialty hospitals has garnered most of the focus in physician relations in recent years, but this trend is a result of a whole series of underlying issues. Our physician partners face continued erosion of physician payments, a sense of a loss of control, and some believe that they can only improve the situation by becoming independent of the hospital. We need to create new venues for physician-hospital partnerships that cut through some of the regulatory quagmires and put patients first.
Our payment system is also in need of an overhaul. We are operating under a reimbursement system that no one would ever intentionally design. It has been cobbled together over the last 25 years. Continuing to patch it will create more adverse incentives that foster more competition without improving health or communities. We need to fundamentally reassess our system and develop a unified vision through partnerships that move our physicians, our hospitals, our trustees, our business partners in the right direction.
The quick-fix mentality has the upper hand now, but there are signs of change. Malcolm Gladwell’s book, The Tipping Point, speaks in terms of starting with small changes and the ripple effect. There are some incredible ripples coming from changes in Massachusetts, Florida and South Carolina. Wisconsin and many other states are working on reform. State innovation may provide the tipping point for a national solution.
At the core, health care is deeply personal for all of us. We all have or will experience the highs and lows of health care. My wife is being treated for breast cancer and that has reinforced for me the strength of the patient-physician relationship. We tend to think in terms of systems, but it starts with that relationship and how personal it is, as well as the importance of teamwork, communication and sensitivity.
Our challenge, in terms of all this system and clinical complexity, is to make sure that health care is incredibly personal and that we always remember that we are dealing with individuals. Health care is not about complexity, it’s not about health systems, and it’s not about buildings. It is about coming together around the patient.
The incredible aspect of this field is that we occupy leadership positions where we can leave our offices and walk the halls and see tragedy and miracles. A hospital is an amazing place, and leading one is incredibly gratifying.
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