A Prediction — and Prescription — for Health Care in 2014

Two health care experts from Vanderbilt University’s Owen Graduate School of Management have weighed in with their thoughts about the health care industry in 2014. R. Lawrence Van Horn, a renowned health care economist and Executive Director of Health Affairs at Owen, discusses his thoughts on how the Affordable Care Act will play out in the coming year. Timothy Vogus, Associate Prof. of Management at Owen, looks at what hospitals can do in 2014 to create a better work environment for employees.

R. Lawrence Van Horn (taken from WalletHub.com)

“The actual enrollment in the public exchanges associated with the ACA will likely be less than was anticipated.  It also appears that the profile of those enrolling is not what had been desired by the planners – that is not enough young healthy people paying rates that are far in excess of the actuarial risk.  As a result it is unclear that the prices for products offered through the public exchange will be sustainable. It further appears that the Medicaid enrollment of individuals who were previously eligible but not enrolled (EBNE) is growing – this will pose increased burdens on state budgets.

In general the ACA likely increases the expenditures in health care – relying on government transfer payments to support this.  Our government is broke.  The ACA does not reduce expenditures and best evidence suggests that it increases the rate of health care expenditures by 1.5% – 2%.  The ability of our country to continue down this undisciplined path is questionable to say the least.”

Timothy Vogus (partially taken from Becker’s Hospital Review)

The healthcare workforce lives in a state of unmitigated risk.  Frontline caregivers exhibit some of the highest injury rates of any industry, experience disproportionately high rates of emotional, mental, and physical exhaustion, and operate in a system where the care they provide injures or kills hundreds of thousands of patients every year.  System level changes and difficult economic conditions also continue to exert substantial strain on hospitals and health systems that has resulted in a wave of significant workforce reductions.   Against this backdrop as well as ongoing policy change, hospitals will need to do more with less.  Doing so will require a highly engaged workforce.  Fostering engagement amidst turmoil necessitates a restoration of meaning in work.  I suggest three non-obvious workplace changes that would be especially helpful under current conditions: leaders commit to safety, reconnect the workforce with their patients, and foster system mindfulness.

Leaders can (re)commit to safety both for caregivers and patients by following the example of the former CEO and Chairman of ALCOA Paul O’Neill by working to ensure that every employee can affirmatively answer three questions every day
1)      Am I treated with dignity and respect by everyone, every day, in each encounter?
2)      Do I have what I need so I can make a contribution that gives meaning to my life?
3)      Am I recognized and thanked for all that I do?

Raising these questions and working toward an affirmative answer helps remove the threats to safety and foster psychological safety that fuels engagement and commitment to doing one’s best work.

Part of making a contribution that gives meaning to one’s life is to reconnect people to the reasons they entered the profession.  For healthcare providers it’s consistently to make a positive difference in people’s lives.  So efforts to reconnect caregivers with patients who have been healed by their efforts can restore meaning in difficult times.  For example, Medtronic connects employees to the medical professionals and patients affected by their products. They do this through Patients coming to the company to meet with employees and to share their stories about how Medtronic products changed their lives.

Lastly, meaning for employees can be restored when they work in a manner that is more mindful.  That is, when caregivers carry out their work jointly and given forums and mechanisms to spend time identifying the potential threats in their environment, discuss alternative ways to carry out their work, and learn from errors and close calls.  Mindfulness also relies on having adequate expertise present and being able to draw upon it in real time.  This manner of working is intensely patient-centered as all the conversations regard how to deliver higher quality, safer care to patients.  My own research shows that more mindful interactions both reduce the patient harm and attenuates emotional exhaustion and reduces nursing turnover over time.

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